Trends and disparities in obesity and atherosclerotic cardiovascular disease mortality in a 25-year retrospective analysis

Obesity is a major risk factor for atherosclerotic cardiovascular disease (ASCVD) and contributes significantly to mortality in the US. We analyzed national mortality trends in obesity-related ASCVD mortality (1999-2023). Age-adjusted mortality rates (AAMRs), crude mortality rates (CMRs), average annual percent change (AAPC), and annual percent change (APC) were calculated per 100,000 population using Joinpoint regression. From 1999 to 2023, a total of 267,315 deaths were attributed to obesity and ASCVD. The AAMR increased from 2.45 in 1999 to 7.23 in 2023, reflecting an overall AAPC of 4.67 (95% CI: 4.05-5.29). The most significant rise occurred between 2018 and 2021 (APC: 14.67, 95% CI: 9.90-19.66). Males had a higher overall AAMR (5.26) compared to females (3.11). By race, Blacks experienced the highest AAMR (5.47), followed by American Indians (4.38), Whites (4.14), and Asians (0.88). Regionally, the Midwest (4.48) and West (4.41) showed higher mortality rates than the Northeast (3.96) and South (3.90). Non-metropolitan areas demonstrated higher mortality (AAMR: 4.98) than metropolitan areas (3.99). CMRs were highest among older adults (9.25), followed by middle-aged (6.33), and lowest among younger individuals (1.48). Obesity-related ASCVD mortality has more than doubled, with pronounced increases after 2018, disproportionately affecting males, Black adults, and non-metropolitan populations.