Rising Obesity-Related Cardiovascular Mortality in the United States, 1999–2020: Accelerating Trends and Widening Disparities

Obesity is a major and growing driver of cardiovascular disease (CVD) in the United States, contributing to hypertension, diabetes, dyslipidemia, and structural cardiac changes that elevate the risk of ischemic heart disease, heart failure, and stroke. After decades of declining CVD mortality, recent national trends show a concerning reversal, coinciding with record-high obesity prevalence. We quantified national trends and disparities in obesity-related CVD mortality from 1999–2020 using de-identified death certificate data from the CDC WONDER database for U.S. residents aged 15–84 years, including deaths with circulatory disease (ICD-10 I00–I99) as the underlying cause and obesity (E66.0–E66.9) as a contributing cause. Age-adjusted mortality rates (AAMR) standardized to the 2000 U.S. population were analyzed using joinpoint regression to estimate annual percent change (APC) and detect inflection points. From 1999–2018, AAMR rose from 2.75 to 6.61 per 100,000 (APC 4.79%; 95% CI 4.60–4.98), followed by a significant post-2018 acceleration (APC 11.05%; 95% CI 6.76–15.51) to 8.36 in 2020. Mortality was highest among adults 65–74 years, males, Black Americans, and nonmetropolitan residents, with a 5.1-fold state variation. Young adults (15–24 years) had the largest relative increase (+210%). The 2020 surge was independent of COVID-19 mortality, indicating gaps in chronic disease management. These results highlight a growing obesity-related CVD mortality burden, with widening disparities by age, sex, race, and geography, emphasizing urgent, equity-focused prevention and targeted interventions.