Trends and disparities of cardiovascular mortality among adults with obesity in the United States from 1999 to 2023

Background Obesity is increasingly recognized as a critical cardiovascular risk factor[1, 2]. However, the long-term comprehensive trends in cardiovascular mortality among adults with obesity remain insufficiently explored. Purpose We analyzed trends in obesity-related cardiovascular mortality across subgroups stratified by sex, age, race, geographic region, urbanization level, and state, and projected these mortality rates through 2030. Methods Cases were selected according to death certificates that listed a circulatory system disease (I00-I99) as the underlying cause, with obesity (E66) also listed as a multiple cause of death. We calculated age-adjusted mortality rates (AAMR) and applied Joinpoint regression analysis to determine the annual percent change (APC) and average annual percent change (AAPC). Results Cardiovascular diseases accounted for 363,203 deaths among US adults with obesity from 1999 to 2023. The overall AAMR showed a significant increase of 6.94 per 100,000 (from 3.40 to 10.34), reflecting an AAPC of 4.88%. Throughout the study period, the AAMR for men remained elevated relative to that for women. All racial groups showed consistent upward trends, with non-Hispanic Black adults consistently demonstrating the highest cardiovascular mortality. Regional disparities widened over time, with the South replacing the West as the region with the highest AAMR. Ischemic heart disease remained the predominant cause, while mortality due to hypertensive diseases showed the highest rate of increase. Projections indicate a 15.3% increase in the AAMR for obesity-related cardiovascular mortality by 2030. Conclusions Between 1999 and 2023, obesity-related cardiovascular mortality in the US demonstrated a persistent and significant upward trend. The enduring gender and racial disparities, coupled with the evolving pattern of contributing cardiovascular diseases, call for immediate and targeted public health policies to address these persistent disparities.