Trends in stroke-related mortality among U.S. adults with obesity: a CDC WONDER analysis from 1999 to 2019

Stroke is a leading cause of death in the United States, and obesity is a major, independent risk factor that worsens vascular and metabolic health. Stroke mortality in obese adults remains underexplored across demographic and geographic subgroups in the U.S. This study aimed to evaluate national trends in stroke-related mortality among U.S. adults aged ≥25 years with obesity from 1999 to 2019, highlighting disparities by sex, race/ethnicity, age, region, and urbanization.

We utilized the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database to extract stroke and obesity-related mortality data among U.S. adults. Age-adjusted mortality rates (AAMRs) were calculated per one million population, and annual percent change as well as average annual percent change (AAPC) in mortality trends were determined using Joinpoint software, with corresponding 95 % confidence intervals. From 1999 to 2019, 23,457 stroke-related deaths occurred among obese adults in the U.S. Overall AAMRs increase from 3.31 to 7.47 (AAPC: +4.2 %; 95 % CI: 3.7 to 4.6; p < 0.001). Women consistently had higher AAMRs than men (5.52 vs 5.11). Non-Hispanic (NH) Black individuals had the highest mortality (9.99), followed by NH Whites (4.61), and Hispanics (3.87). The West had the highest rates (5.87), and rural areas exhibited higher AAMRs than urban areas (6.99 vs 4.88).

There was a significant increase in obesity-related stroke mortality from 1999 to 2019, with notable disparities across demographic subgroups. These findings highlight the need for targeted public health strategies and policies aimed at high-risk populations. However, interpretation should consider key limitations, including the known under recognition of obesity on death certificates and exclusion of certain racial and ethnic groups due to small sample sizes.