There has been a three-fold increase in obesity-related deaths from cardiovascular disease in the US between 1999 and 2020, according to an international team of researchers. Overall, obesity-related cardiovascular disease deaths tripled from 2.2 per 100,000 population to 6.6 per 100,000 population between 1999 and 2020 (Figure 1).
"The number of people with obesity is rising in every country across the world. Our study is the first to demonstrate that this increasing burden of obesity is translating into rising heart disease deaths," said lead study author and cardiologist, Dr Zahra Raisi-Estabragh, a clinical lecturer at the William Harvey Research Institute in London. "This rising trend of obesity is affecting some populations more than others, particularly Black women."
Obesity remains a global public health crisis and is a major risk factor for cardiovascular disease. It currently affects about 42% of the US population, an increase by almost 10% from the preceding decade, according to the American Heart Association's 2023 statistics.
For their study, researchers analysed race, gender, and urban versus rural settings to determine differences in heart disease deaths in which obesity was listed as a contributing factor. From 1999 to 2020, there were 281,135 deaths in which obesity was recorded as a contributing factor in. The Multiple Cause of Death database includes mortality and population counts from all US counties. Among the deaths, 43.6% were in women; 78.1% of the group were white adults; 19.8% were Black adults; 1.1% were Asian or Pacific Islander adults and 1% were American Indian adults or Alaskan Native adults.
Among the findings:
Obesity-related cardiovascular disease deaths were higher among Black individuals compared with any other racial group, at 6.7 per 100,000 population; followed by American Indian adults or Alaska Native adults at 3.8 per 100,000.
Black women had the highest rates of obesity-related heart disease deaths than all others in the study. In other racial groups, men experienced more obesity-related heart disease deaths than women.
Black adults living in urban areas had higher rates of obesity-related heart disease deaths compared with Black adults living in rural areas, (6.8 versus 5.9 per 100,000) whereas rural living was associated with higher rates of obesity-related heart deaths for people in all other racial groups.
"The trend of higher obesity-related cardiovascular death rates for Black women than men was striking and different from all other racial groups considered in our study," said senior author, Dr Mamas A Mamas, professor of Cardiovascular Medicine from Keele University in Keele, UK.
In addition, Raisi-Estabaugh noted that Black individuals living in urban communities may be impacted more by socioeconomic deprivation and health inequalities than Black people living in rural areas, and that they did not benefit from increased access to health care that appears to benefit people of other racial groups who live in urban areas.
The researchers note that coding and data entry errors may be a limitation of the findings since the source was electronic health records that could not be verified by researchers for accuracy. However, the results still underscore the need to address obesity more effectively in individuals and communities.
“In this large population‐level analysis of mortality data, we demonstrate a substantial rise in cardiovascular mortality related to obesity in the US population over the past 2 decades between 1999 and 2020. This is in contrast to general cardiovascular mortality trends, which have steadily declined over the same time period “ the authors concluded. “There is need for dedicated health strategies aimed at individual communities to better understand and tackle the social determinants of obesity and to design interventions that may alleviate the population burden of both obesity and cardiovascular disease.”
The findings were featured in the paper, ‘Racial Disparities in Obesity-Related Cardiovascular Mortality in the United States: Temporal Trends From 1999 to 2020’, published in the Journal of the American Heart Association.
To access this paper, please click here