Temporal Trends and Disparities in Cardiovascular Mortality Among Adults With Obesity in the United States From 1999...

Obesity prevalence in the United States has surged dramatically, yet comprehensive analysis of cardiovascular mortality patterns among adults with obesity remains lacking.

We analyzed CDC WONDER Multiple Cause of Death data for adults aged ≥ 25 years in the United States (1999-2023), identifying deaths where cardiovascular disease was the underlying cause and obesity was a contributing cause. Age-adjusted mortality rates (AAMR) per 100,000 population were calculated. Joinpoint regression analysis identified temporal trends stratified by sex, age, race/ethnicity, and geographic region.

Among 363,203 cardiovascular deaths, AAMR tripled from 3.40 to 10.34 per 100,000 (average annual percent change [AAPC]: +4.88%). Three distinct phases emerged: steady increase (1999-2018), pandemic acceleration (2018-2021, 12.22% annual increase), and recent decline (2021-2023). Men had higher mortality than women (12.69 vs. 8.06 per 100,000 in 2023). The 75-84 years group showed the steepest increase (AAPC: +5.66%). Non-Hispanic Black adults maintained the highest AAMR (18.30 per 100,000 in 2023). The South transformed from lowest to highest regional burden (AAPC: +5.52%). The disease spectrum shifted toward atherosclerotic and hypertensive conditions.

Cardiovascular mortality among US adults with obesity tripled over 25 years, with widening disparities across demographic and geographic groups, necessitating equitable public health interventions targeting high-risk populations.