Obesity-related heart disease deaths triple since 1999, with highest impact on Black women
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September 06, 2023
3 min read
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The authors report no relevant financial disclosures.
Key takeaways:
- The obesity-related CV death rate in the U.S. rose threefold from 1999 to 2020.
- Deaths were higher among Black adults, followed by Indigenous U.S. adults.
CV deaths related to obesity increased by 200% across all race groups from 1999 to 2020, a statistic researchers said reflects the health consequences of the rising burden of obesity in the United States.
In an analysis of more than 280,000 CV deaths in the U.S. with obesity recorded as a contributing cause, researchers also found that Black women had the highest rates of obesity-related CVD deaths than all others, a trend researchers called unexpected.
Data were derived from Raisi-Estabragh Z, et al. J Am Heart Assoc. 2023;doi:10.1161/JAHA.122.028409.
“Our study is the first to demonstrate the increasing population burden of obesity is translating into rising trends of heart disease death, which is the reverse of the general declining trend in heart disease deaths,” Zahra Raisi-Estabragh, MD, PhD, a clinical lecturer in cardiology at the William Harvey Research Institute in London, told Healio. “We found that these harmful cardiovascular effects of obesity affected some communities more than others. For example, people from Black racial backgrounds had a higher rate of cardiovascular death related to obesity than any other racial group throughout the entire 10 years. On the other hand, people from American Indian or Native Alaska background had the steepest increase in heart disease deaths related to obesity.”
Raisi-Estabragh and colleagues analyzed data from 281,135 adults with primary CV death and obesity recorded as a contributing cause of death, using the Multiple Cause of Death database. CV deaths were further defined as ischemic heart disease, HF, hypertensive disease, cerebrovascular disease and other. Researchers calculated absolute, crude and age-adjusted mortality rates (AAMRs) by race, considering temporal trends and variation by sex, age and residence (urban vs. rural).
The findings were published in the Journal of the American Heart Association.
Within the cohort, 43.6% of deaths were in women; 78.1% were white; 19.8% were Black; 1.1% were Asian or Pacific Islander and 1% were American Indian or Alaska Native.
Overall, researchers observed a –17.6% reduction in the crude rate of all CV deaths from 1999 to 2020, which was consistent across all races.
In contrast to overall CV mortality trends, age-adjusted obesity-related CV mortality tripled from 1999 to 2020, with an increase in AAMRs from 2.2 per 100,000 population to 6.6 per 100,000 population, a 200% increase. The increasing trend was consistent across all race groups; however, Black adults had the highest AAMRs and American Indian or Alaska Native adults had the greatest temporal increase in AAMRs at 415%.
The most common primary cause of death was ischemic heart disease, followed by hypertensive disease, which was most common among Black adults (31%).
Among Black adults, women had higher AAMRs than men, with rates of 6.7 per 100,000 population vs. 6.6 per 100,000 population. However, across all other racial groups, men had a greater proportion of obesity-related CV mortality cases and higher AAMRs, according to the researchers.
“This is an unexpected finding, because in unselected epidemiologic reports, women generally have lower CV risk compared with men,” the researchers wrote. “The disproportionate adverse health experiences of Black women have been highlighted across several settings including mental health, maternal outcomes and CV health. Black women are among the most vulnerable cohorts in society, facing disadvantage across a host of social and economic measures, which has been shown to translate into significant health inequalities.”
Black adults also had greater AAMRs when living in urban vs. rural settings (6.8 per 100,000 population vs. 5.9 per 100,000 population); whereas the reverse was observed for all other races, with greater age-adjusted death in rural vs. urban settings.
“We demonstrate the growing public health importance of obesity as a driver of cardiovascular deaths, which impacts some communities more than others,” Raisi-Estabragh told Healio. “There is need for population-level interventions to tackle obesity, and these intervention should be paired with effects tailored to specific vulnerable communities who are disproportionately impacted.”
For more information:
Zahra Raisi-Estabragh, MD, PhD, can be reached at zahraraisi@doctors.org.uk; X (Twitter): @zahra_raisi.
Race and Medicine
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