Temporal Trends and Disparities in Cardiovascular Mortality Among Adults With Obesity in the United States From 1999 to 2023

OBJECTIVE: Obesity prevalence in the United States has surged dramatically, yet comprehensive analysis of cardiovascular mortality patterns among adults with obesity remains lacking. METHODS: We analyzed CDC WONDER Multiple Cause of Death data for adults aged ≥ 25 years in the United States (1999-2023), identifying deaths where cardiovascular disease was the underlying cause and obesity was a contributing cause. Age-adjusted mortality rates (AAMR) per 100,000 population were calculated. Joinpoint regression analysis identified temporal trends stratified by sex, age, race/ethnicity, and geographic region. RESULTS: Among 363,203 cardiovascular deaths, AAMR tripled from 3.40 to 10.34 per 100,000 (average annual percent change [AAPC]: +4.88%). Three distinct phases emerged: steady increase (1999-2018), pandemic acceleration (2018-2021, 12.22% annual increase), and recent decline (2021-2023). Men had higher mortality than women (12.69 vs. 8.06 per 100,000 in 2023). The 75-84 years group showed the steepest increase (AAPC: +5.66%). Non-Hispanic Black adults maintained the highest AAMR (18.30 per 100,000 in 2023). The South transformed from lowest to highest regional burden (AAPC: +5.52%). The disease spectrum shifted toward atherosclerotic and hypertensive conditions. CONCLUSIONS: Cardiovascular mortality among US adults with obesity tripled over 25 years, with widening disparities across demographic and geographic groups, necessitating equitable public health interventions targeting high-risk populations.