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. 2023 Sep 19;12(18):e028409.
doi: 10.1161/JAHA.122.028409. Epub 2023 Sep 6.

Racial Disparities in Obesity-Related Cardiovascular Mortality in the United States: Temporal Trends From 1999 to 2020

Zahra Raisi-Estabragh  1   2 , Ofer Kobo  3   4 , Jennifer H Mieres  5 , Renee P Bullock-Palmer  6 , Harriette G C Van Spall  7 , Khadijah Breathett  8 , Mamas A Mamas  3   9
Affiliations

Racial Disparities in Obesity-Related Cardiovascular Mortality in the United States: Temporal Trends From 1999 to 2020

Zahra Raisi-Estabragh et al. J Am Heart Assoc. .

Abstract

Background Obesity is a major risk factor for cardiovascular disease, with differential impact across populations. This descriptive epidemiologic study outlines trends and disparities in obesity-related cardiovascular mortality in the US population between 1999 and 2020. Methods and Results The Multiple Cause of Death database was used to identify adults with primary cardiovascular death and obesity recorded as a contributing cause of death. Cardiovascular deaths were grouped into ischemic heart disease, heart failure, hypertensive disease, cerebrovascular disease, and other. Absolute, crude, and age-adjusted mortality rates (AAMRs) were calculated by racial group, considering temporal trends and variation by sex, age, and residence (urban versus rural). Analysis of 281 135 obesity-related cardiovascular deaths demonstrated a 3-fold increase in AAMRs from 1999 to 2020 (2.2-6.6 per 100 000 population). Black individuals had the highest AAMRs. American Indian or Alaska Native individuals had the greatest temporal increase in AAMRs (+415%). Ischemic heart disease was the most common primary cause of death. The second most common cause of death was hypertensive disease, which was most common in the Black racial group (31%). Among Black individuals, women had higher AAMRs than men; across all other racial groups, men had a greater proportion of obesity-related cardiovascular mortality cases and higher AAMRs. Black individuals had greater AAMRs in urban compared with rural settings; the reverse was observed for all other races. Conclusions Obesity-related cardiovascular mortality is increasing with differential trends by race, sex, and place of residence.

Keywords: body mass index; cardiovascular disease; epidemiology; ethnicity; health inequalities; public health.

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Figures

Figure 1
Figure 1. Overview of study findings.
Asian refers to Asian or Pacific Islander. American Indian refers to American Indian or Alaska Native. AAMR indicates age‐adjusted mortality rate; and CV, cardiovascular.
Figure 2
Figure 2. Temporal trends in obesity‐related age‐adjusted cardiovascular mortality in the United States between 1999 and 2020, stratified by race.
Figure 3
Figure 3. Distribution of primary cardiovascular causes of death in individuals with obesity as a contributory cause, stratified by racial group. American Indian refers to American Indian or Alaska Native; Asian refers to Asian or Pacific Islander; Black refers to Black or African American.
Figure 4
Figure 4. Age‐adjusted obesity‐related cardiovascular mortality rate, stratified by sex and race.
Figure 5
Figure 5. Age‐adjusted obesity‐related cardiovascular mortality rate, stratified by urbanization and race.
See this image and copyright information in PMC

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