Rising Obesity‐Driven Cardiac Mortality Among Young Adults in the United States: A 25‐Year Retrospective Analysis (1999–2023)

Background Obesity is a growing risk factor for cardiovascular disease and mortality in the United States, particularly among younger adults. Methods Using the Centers for Disease Control and Prevention Wide‐Ranging Online Data for Epidemiologic Research Multiple Cause of Death database, we retrospectively analyzed trends and disparities in obesity‐related cardiac mortality among US individuals aged 15 to 44 years from 1999 to 2023, stratified by sex, race, urbanization, and census region. Deaths were identified using International Classification of Diseases, Tenth Revision ( ICD‐10 ) codes for obesity and cardiac conditions, including ischemic heart disease, sudden cardiac death, arrhythmias, and heart failure. Age‐adjusted mortality rates were calculated using joinpoint regression and expressed as annual percentage change with 95% CIs. Results Between 1999 and 2023, 51 860 obesity‐related cardiac deaths were recorded. The age‐adjusted mortality rates increased from 0.9 (95% CI, 0.8–0.9) to 2.5 (95% CI, 2.4–2.6) per 100 000. Mortality was highest during the COVID‐19 pandemic (2019–2021). Men consistently had higher age‐adjusted mortality rates than women. Black or African American and American Indian/Alaska Native individuals showed the highest racial disparities. The South and nonmetropolitan areas had the highest regional mortality, with Alaska recording the highest state‐level age‐adjusted mortality rate in 2023 (6.0 per 100 000). Mortality largely returned to baseline across most groups from 2021 to 2023. Conclusions Obesity‐related cardiac mortality has risen in the United States over the past 2 decades with notable disparities across sex, race, region, and urbanization. These findings underscore the need for targeted public health interventions in high‐risk populations to reduce premature cardiovascular deaths and reverse this trend.