Obesity-related cardiovascular disease deaths tripled between 1999 and 2020, study shows

There has been a three-fold increase in obesity-related deaths from heart disease in the U.S. between 1999 and 2020, according to new research published today in the Journal of the American Heart Association.

"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 Zahra Raisi-Estabragh, M.D., 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 U.S. population, an increase by almost 10% from the preceding decade, according to the American Heart Association's 2023 statistics.

Researchers analyzed race, gender, and urban versus rural settings to determine differences in heart disease deaths in which obesity was listed as a contributing factor. Among the findings:

• 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.
• 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 Mamas A. Mamas, M.D., D.Phil. professor of Cardiovascular Medicine from Keele University in Keele, United Kingdom.

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.

Researchers analyzed data collected from 1999 to 2020 on 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 U.S. 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.

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.