Racial Disparities in Obesity‐Related Cardiovascular Mortality in the United States: Temporal Trends From 1999 to 2020

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Abstract

Background

Obesity is a major risk factor for cardiovascular disease, with differential impact across populations. This descriptive epidemiologic study outlines trends and disparities in obesity‐related cardiovascular mortality in the US population between 1999 and 2020.

Methods and Results

The Multiple Cause of Death database was used to identify adults with primary cardiovascular death and obesity recorded as a contributing cause of death. Cardiovascular deaths were grouped into ischemic heart disease, heart failure, hypertensive disease, cerebrovascular disease, and other. Absolute, crude, and age‐adjusted mortality rates (AAMRs) were calculated by racial group, considering temporal trends and variation by sex, age, and residence (urban versus rural). Analysis of 281 135 obesity‐related cardiovascular deaths demonstrated a 3‐fold increase in AAMRs from 1999 to 2020 (2.2‐6.6 per 100 000 population). Black individuals had the highest AAMRs. American Indian or Alaska Native individuals had the greatest temporal increase in AAMRs (+415%). Ischemic heart disease was the most common primary cause of death. The second most common cause of death was hypertensive disease, which was most common in the Black racial group (31%). Among Black individuals, women had higher AAMRs than men; across all other racial groups, men had a greater proportion of obesity‐related cardiovascular mortality cases and higher AAMRs. Black individuals had greater AAMRs in urban compared with rural settings; the reverse was observed for all other races.

Conclusions

Obesity‐related cardiovascular mortality is increasing with differential trends by race, sex, and place of residence.

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Most cited references 32

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Global Burden of Cardiovascular Diseases and Risk Factors, 1990–2019

Gregory A Roth, George A Mensah, Catherine O. Johnson … (2022)

Cardiovascular diseases (CVDs), principally ischemic heart disease (IHD) and stroke, are the leading cause of global mortality and a major contributor to disability. This paper reviews the magnitude of total CVD burden, including 13 underlying causes of cardiovascular death and 9 related risk factors, using estimates from the Global Burden of Disease (GBD) Study 2019. GBD, an ongoing multinational collaboration to provide comparable and consistent estimates of population health over time, used all available population-level data sources on incidence, prevalence, case fatality, mortality, and health risks to produce estimates for 204 countries and territories from 1990 to 2019. Prevalent cases of total CVD nearly doubled from 271 million (95% uncertainty interval [UI]: 257 to 285 million) in 1990 to 523 million (95% UI: 497 to 550 million) in 2019, and the number of CVD deaths steadily increased from 12.1 million (95% UI:11.4 to 12.6 million) in 1990, reaching 18.6 million (95% UI: 17.1 to 19.7 million) in 2019. The global trends for disability-adjusted life years (DALYs) and years of life lost also increased significantly, and years lived with disability doubled from 17.7 million (95% UI: 12.9 to 22.5 million) to 34.4 million (95% UI:24.9 to 43.6 million) over that period. The total number of DALYs due to IHD has risen steadily since 1990, reaching 182 million (95% UI: 170 to 194 million) DALYs, 9.14 million (95% UI: 8.40 to 9.74 million) deaths in the year 2019, and 197 million (95% UI: 178 to 220 million) prevalent cases of IHD in 2019. The total number of DALYs due to stroke has risen steadily since 1990, reaching 143 million (95% UI: 133 to 153 million) DALYs, 6.55 million (95% UI: 6.00 to 7.02 million) deaths in the year 2019, and 101 million (95% UI: 93.2 to 111 million) prevalent cases of stroke in 2019. Cardiovascular diseases remain the leading cause of disease burden in the world. CVD burden continues its decades-long rise for almost all countries outside high-income countries, and alarmingly, the age-standardized rate of CVD has begun to rise in some locations where it was previously declining in high-income countries. There is an urgent need to focus on implementing existing cost-effective policies and interventions if the world is to meet the targets for Sustainable Development Goal 3 and achieve a 30% reduction in premature mortality due to noncommunicable diseases.

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Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults

Leandra Abarca-Gómez, Ziad A Abdeen, Zargar Abdul Hamid … (2019)

Summary Background Underweight, overweight, and obesity in childhood and adolescence are associated with adverse health consequences throughout the life-course. Our aim was to estimate worldwide trends in mean body-mass index (BMI) and a comprehensive set of BMI categories that cover underweight to obesity in children and adolescents, and to compare trends with those of adults. Methods We pooled 2416 population-based studies with measurements of height and weight on 128·9 million participants aged 5 years and older, including 31·5 million aged 5–19 years. We used a Bayesian hierarchical model to estimate trends from 1975 to 2016 in 200 countries for mean BMI and for prevalence of BMI in the following categories for children and adolescents aged 5–19 years: more than 2 SD below the median of the WHO growth reference for children and adolescents (referred to as moderate and severe underweight hereafter), 2 SD to more than 1 SD below the median (mild underweight), 1 SD below the median to 1 SD above the median (healthy weight), more than 1 SD to 2 SD above the median (overweight but not obese), and more than 2 SD above the median (obesity). Findings Regional change in age-standardised mean BMI in girls from 1975 to 2016 ranged from virtually no change (−0·01 kg/m2 per decade; 95% credible interval −0·42 to 0·39, posterior probability [PP] of the observed decrease being a true decrease=0·5098) in eastern Europe to an increase of 1·00 kg/m2 per decade (0·69–1·35, PP>0·9999) in central Latin America and an increase of 0·95 kg/m2 per decade (0·64–1·25, PP>0·9999) in Polynesia and Micronesia. The range for boys was from a non-significant increase of 0·09 kg/m2 per decade (−0·33 to 0·49, PP=0·6926) in eastern Europe to an increase of 0·77 kg/m2 per decade (0·50–1·06, PP>0·9999) in Polynesia and Micronesia. Trends in mean BMI have recently flattened in northwestern Europe and the high-income English-speaking and Asia-Pacific regions for both sexes, southwestern Europe for boys, and central and Andean Latin America for girls. By contrast, the rise in BMI has accelerated in east and south Asia for both sexes, and southeast Asia for boys. Global age-standardised prevalence of obesity increased from 0·7% (0·4–1·2) in 1975 to 5·6% (4·8–6·5) in 2016 in girls, and from 0·9% (0·5–1·3) in 1975 to 7·8% (6·7–9·1) in 2016 in boys; the prevalence of moderate and severe underweight decreased from 9·2% (6·0–12·9) in 1975 to 8·4% (6·8–10·1) in 2016 in girls and from 14·8% (10·4–19·5) in 1975 to 12·4% (10·3–14·5) in 2016 in boys. Prevalence of moderate and severe underweight was highest in India, at 22·7% (16·7–29·6) among girls and 30·7% (23·5–38·0) among boys. Prevalence of obesity was more than 30% in girls in Nauru, the Cook Islands, and Palau; and boys in the Cook Islands, Nauru, Palau, Niue, and American Samoa in 2016. Prevalence of obesity was about 20% or more in several countries in Polynesia and Micronesia, the Middle East and north Africa, the Caribbean, and the USA. In 2016, 75 (44–117) million girls and 117 (70–178) million boys worldwide were moderately or severely underweight. In the same year, 50 (24–89) million girls and 74 (39–125) million boys worldwide were obese. Interpretation The rising trends in children's and adolescents' BMI have plateaued in many high-income countries, albeit at high levels, but have accelerated in parts of Asia, with trends no longer correlated with those of adults. Funding Wellcome Trust, AstraZeneca Young Health Programme.

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Health Effects of Overweight and Obesity in 195 Countries over 25 Years.

Ashkan Afshin, Mohammad Forouzanfar, Marissa Reitsma … (2018)

Background While the rising pandemic of obesity has received significant attention in many countries, the effect of this attention on trends and the disease burden of obesity remains uncertain. Methods We analyzed data from 67.8 million individuals to assess the trends in obesity and overweight prevalence among children and adults between 1980 and 2015. Using the Global Burden of Disease study data and methods, we also quantified the burden of disease related to high body mass index (BMI), by age, sex, cause, and BMI level in 195 countries between 1990 and 2015. Results In 2015, obesity affected 107.7 million (98.7-118.4) children and 603.7 million (588.2- 619.8) adults worldwide. Obesity prevalence has doubled since 1980 in more than 70 countries and continuously increased in most other countries. Although the prevalence of obesity among children has been lower than adults, the rate of increase in childhood obesity in many countries was greater than the rate of increase in adult obesity. High BMI accounted for 4.0 million (2.7- 5.3) deaths globally, nearly 40% of which occurred among non-obese. More than two-thirds of deaths related to high BMI were due to cardiovascular disease. The disease burden of high BMI has increased since 1990; however, the rate of this increase has been attenuated due to decreases in underlying cardiovascular disease death rates. Conclusions The rapid increase in prevalence and disease burden of elevated BMI highlights the need for continued focus on surveillance of BMI and identification, implementation, and evaluation of evidence-based interventions to address this problem.

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Author and article information

Contributors

Mamas A. Mamas:

ORCID: https://orcid.org/0000-0001-9241-8890

mamasmamas1@yahoo.co.uk

Journal

Journal ID (nlm-ta): J Am Heart Assoc

Journal ID (iso-abbrev): J Am Heart Assoc

Journal ID (doi): 10.1002/(ISSN)2047-9980

Journal ID (publisher-id): JAH3

Journal ID (hwp): ahaoa

Title: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease

Publisher: John Wiley and Sons Inc. (Hoboken )

ISSN (Electronic): 2047-9980

Publication date (Electronic): 06 September 2023

Publication date Collection: 19 September 2023

Volume: 12

Issue: 18 ( doiID: 10.1002/jah3.v12.18 )

Electronic Location Identifier: e028409

Affiliations

[ ¹ ] William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Centre for Advanced Cardiovascular Imaging Queen Mary University London United Kingdom

[ ² ] Barts Heart Centre, St. Bartholomew’s Hospital Barts Health NHS Trust, West Smithfield London United Kingdom

[ ³ ] Keele Cardiovascular Research Group Keele University Keele United Kingdom

[ ⁴ ] Department of Cardiology Hillel Yaffe Medical Center Hadera Israel

[ ⁵ ] Department of Cardiology, Hofstra Northwell School of Medicine Hofstra University, Lake Success New York NY USA

[ ⁶ ] Department of Cardiology Deborah Heart and Lung Center Brown Mills NJ USA

[ ⁷ ] Department of Medicine, Department of Health Research Methods, Evidence, and Impact, Population Health Research Institute Research Institute of St. Joe’s, McMaster University Hamilton Ontario Canada

[ ⁸ ] Division of Cardiovascular Medicine, Department of Medicine Indiana University Indianapolis IN USA

[ ⁹ ] Institute of Population Health University of Manchester Manchester United Kingdom

Author notes

[*] [* ]Correspondence to: Mamas A. Mamas, Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke‐on‐Trent, United Kingdom. Email: mamasmamas1@ 123456yahoo.co.uk

[*]

Z. Raisi‐Estabragh and O. Kobo contributed equally and are co–first authors.

Author information

Zahra Raisi‐Estabragh https://orcid.org/0000-0002-7757-5465

Renee P. Bullock‐Palmer https://orcid.org/0000-0001-8167-5760

Harriette G.C. Van Spall https://orcid.org/0000-0002-8370-4569

Khadijah Breathett https://orcid.org/0000-0001-5397-6419

Mamas A. Mamas https://orcid.org/0000-0001-9241-8890

Article

Publisher ID: JAH38691 Other ID: JAHA/2022/028409

DOI: 10.1161/JAHA.122.028409

PMC ID: 10547286

PubMed ID: 37671611

SO-VID: 448e22c7-e97f-4444-9332-c971e0933021

License:

This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

History

Date received : 06 October 2022

Date accepted : 07 July 2023

Page count

Figures: 5, Tables: 2, Pages: 11, Words: 5728

Funding

Funded by: British Heart Foundation Clinical Research Training Fellowship

Award ID: FS/17/81/33318)

Funded by: National Heart, Lung, and Blood Institute , doi 10.13039/100000050;

Award ID: L30HL14888)

Award ID: R56HL159216

Award ID: K01HL142848

Custom metadata

source-schema-version-number 2.0

cover-date 19 September 2023

details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:6.3.4 mode:remove_FC converted:19.09.2023

ScienceOpen disciplines: Cardiovascular Medicine

Keywords: body mass index,cardiovascular disease,epidemiology,ethnicity,health inequalities,public health,disparities,obesity

Data availability:

ScienceOpen disciplines: Cardiovascular Medicine

Keywords: body mass index, cardiovascular disease, epidemiology, ethnicity, health inequalities, public health, disparities, obesity

Racial Disparities in Obesity‐Related Cardiovascular Mortality in the United States: Temporal Trends From 1999 to 2020

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Cardiovascular Innovations and Applications

Most cited references 32

Global Burden of Cardiovascular Diseases and Risk Factors, 1990–2019

Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults

Health Effects of Overweight and Obesity in 195 Countries over 25 Years.

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