What is the clinical evidence from this study?

Study design: Observational. Population: Obesity-related cardiovascular mortality. Primary outcome: Temporal trends in age-adjusted mortality rates (AAMRs) measured by average annual percent change (AAPC).

March 20, 2026Open Access

Disparities in obesity-related cardiovascular-induced mortality trends in the U.S. of America over two decades

Resultado clave

Obesity-related cardiovascular mortality in the U.S. increased significantly from 1999 to 2020, with males showing a steeper average annual percent change than females (5.94% vs. 4.40%).

Diseño del estudio

Tipo

Observational

PICO estructurado

Población

Adults aged ≥25 years in the U.S. with cardiovascular disease mortality and obesity listed as a contributing cause on death certificates (1999-2020)

Resultado

Age-adjusted mortality rates (AAMRs) for CVD with obesity listed as a contributing causehard clinical

Obesity-related cardiovascular mortality in the U.S. has increased significantly over the past two decades, with disproportionate impacts on males, non-Hispanic Black populations, and rural areas.

Limitaciones

Ecological analysis based on aggregated mortality data, precluding individual-level causal inferences
Reliance on death certificate data, which may be subject to misclassification and temporal changes in coding practices
Absence of individual-level clinical, socioeconomic, and behavioral information precludes adjustment for confounders
Joinpoint regression identifies inflection points but does not provide insight into underlying drivers
Data available only through 2020
ICD-10 codes I00-I99 encompass a broad spectrum of cardiovascular conditions, limiting subtype-specific insights

Resumen

Background: Cardiovascular disease (CVD) remains the leading cause of death in the U.S., and the growing prevalence of obesity has amplified this burden. Despite extensive research on their pathophysiologic interplay, long-term mortality trends among adults with both conditions remain insufficiently characterized. Methods: Using national death certificate data from the CDC WONDER database (1999-2020), we examined age-adjusted mortality rates (AAMRs) for CVD with obesity listed as a contributing cause among adults aged ≥25 years. Temporal trends were analyzed using joinpoint regression to estimate annual percent change (APC) and average annual percent change (AAPC) with 95% confidence intervals, stratified by sex, ethnicity, census region, state, and urbanization level. Results: From 1999 to 2020, the national AAMR increased steadily across all subgroups. Males had higher mortality and a steeper rise than females (AAPC 5.94% vs. 4.40%), with female rates accelerating after 2018. Non-Hispanic Black (NH Black) adults consistently experienced the highest mortality, while Hispanic and NH Black populations exhibited the sharpest recent increases. The South and Midwest regions showed the fastest growth (AAPC >5%), and nonmetropolitan areas surpassed metropolitan ones (AAPC 5.69% vs. 4.98%). Oklahoma displayed the most pronounced escalation nationwide (AAPC 10.52%). Conclusions: Over two decades, obesity-related CVD mortality has risen markedly and unevenly across demographic and geographic lines in the U.S. These findings highlight the intensifying intersection of cardiometabolic disease and social inequity, underscoring the urgent need for equity-centered prevention and investment in vulnerable communities.

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