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. 2020 Aug 4;18(1):199.
doi: 10.1186/s12916-020-01666-y.

The role of overweight and obesity in adverse cardiovascular disease mortality trends: an analysis of multiple cause of death data from Australia and the USA

Tim Adair  1 , Alan D Lopez  2
Affiliations

The role of overweight and obesity in adverse cardiovascular disease mortality trends: an analysis of multiple cause of death data from Australia and the USA

Tim Adair et al. BMC Med. .

Abstract

Background: In recent years, there have been adverse trends in premature cardiovascular disease (CVD) mortality rates (35-74 years) in the USA and Australia. Following long-term declines, rates in the USA are now increasing while falls in Australia have slowed rapidly. These two countries also have the highest adult obesity prevalence of high-income countries. This study investigates the role of overweight and obesity in their recent CVD mortality trends by using multiple cause of death (MCOD) data-direct individual-level evidence from death certificates-and linking the findings to cohort lifetime obesity prevalence.

Methods: We identified overweight- and obesity-related mortality as any CVD reported on the death certificate (CVD MCOD) with one or more of diabetes, chronic kidney disease, obesity, lipidemias or hypertensive heart disease (DKOLH-CVD), causes strongly associated with overweight and obesity. DKOLH-CVD comprises 50% of US and 40% of Australian CVD MCOD mortality. Trends in premature age-standardized death rates were compared between DKOLH-CVD and other CVD MCOD deaths (non-DKOLH-CVD). Deaths from 2000 to 2017 in the USA and 2006-2016 in Australia were analyzed. Trends in in age-specific DKOLH-CVD death rates were related to cohort relative lifetime obesity prevalence.

Results: Each country's DKOLH-CVD mortality rate rose by 3% per annum in the most recent year, but previous declines had reversed more rapidly in Australia. Non-DKOLH-CVD mortality in the USA increased in 2017 after declining strongly in the early 2000s, but in Australia it has continued declining in stark contrast to DKOLH-CVD. There were larger increases in DKOLH-CVD mortality rates at successively younger ages, strongly related with higher relative lifetime obesity prevalence in younger cohorts.

Conclusions: The increase in DKOLH-CVD mortality in each country suggests that overweight and obesity has likely been a key driver of the recent slowdown or reversal of CVD mortality decline in both countries. The larger recent increases in DKOLH-CVD mortality and higher lifetime obesity prevalence in younger age groups are very concerning and are likely to adversely impact CVD mortality trends and hence life expectancy in future. MCOD data is a valuable but underutilized source of data to track important mortality trends.

Keywords: Cardiovascular diseases; Chronic kidney disease; Diabetes; Hypertensive heart disease; Mortality; Multiple causes of death; Obesity.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Annual change in age-standardized CVD UCOD and MCOD death rates (%), all ages, and ages 35–74 years, by sex, Australia (2007–2016) and the USA (2001–2017)
Fig. 2
Fig. 2
Annual change in age-standardized DKOLH-CVD and non-DKOLH-CVD CVD MCOD death rates (%), 35–74 years, by sex, Australia (2007–2016) and the USA (2001–2017)
Fig. 3
Fig. 3
Annualized change in DKOLH-CVD and non-DKOLH-CVD MCOD age-specific death rates (% and 95% confidence intervals), by sex, Australia (2006 to 2016) and the USA (2005 to 2017). Bars indicate 95% confidence intervals
Fig. 4
Fig. 4
Percentage of DKOLH-CVD deaths with obesity reported, by cohort age group, and relative lifetime obesity prevalence of cohort, 1980–2015, Australia (2006–2016) and the USA (2005–2017) (%). Prev., prevalence. Age is cohort age at 2017 in the USA and 2016 in Australia
See this image and copyright information in PMC

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