Abstract 4369704: Racial, Gender, and Comorbidity Predictors of Cardiovascular Mortality in Class III Obesity: Insights from the National Inpatient Sample

Background: Class III obesity (BMI ≥40 kg/m2) represents a growing public health challenge and is closely associated with cardiovascular disease (CVD). This study investigates clinical outcomes, healthcare disparities, and resource utilization in patients with morbid obesity and underlying CVD. Methods: We conducted a retrospective cohort study using data from the National Inpatient Sample (NIS), part of the Healthcare Cost and Utilization Project (HCUP), covering hospitalizations between 2019 and 2020. Adults with class III obesity and a diagnosis of CVD—including hypertensive disease, ischemic heart disease, heart failure, and cerebrovascular disease—were identified using ICD-10 codes. The primary outcome was in-hospital mortality. Secondary outcomes included total hospitalization costs and length of stay (LOS). Multivariate logistic regression was used to identify predictors of mortality. Results: A total of 1,599,800 CVD-related hospitalizations in patients with class III obesity were identified. In-hospital mortality occurred in 2% of cases. The mean (±SD) patient age was 62 ± 13 years. White patients were significantly older than their Black and Hispanic counterparts (65 vs. 59 vs. 58 years; p<0.001). In adjusted models, Black patients had lower odds of in-hospital mortality compared to White patients (OR 0.81; 95% CI, 0.72–0.91; p<0.001). Female sex was also associated with reduced odds of mortality compared to males (OR 0.88; 95% CI, 0.80–0.97; p=0.008). Comorbid conditions such as diabetes mellitus (DM), human immunodeficiency virus (HIV), and chronic obstructive pulmonary disease (COPD) were independently associated with increased mortality. Racial and ethnic differences were also observed in LOS (White: 5.8 days, Black: 6.1 days, Hispanic: 5.7 days; p<0.001) and total hospital charges. Conclusions: Among patients with class III obesity and CVD, Black race and female sex were associated with lower in-hospital mortality. In contrast, comorbidities such as DM, HIV, and COPD were linked to higher mortality risk. Notable disparities in LOS and healthcare expenditures across racial and ethnic groups underscore persistent inequities in care delivery and outcomes in this high-risk population.