Abstract Body (Do not enter title and authors here): Introduction:
Obesity is a cardinal national health concern firmly linked to cardiovascular disease and a primary driver of hypertension (HTN) through mechanisms such as neurohormonal, metabolic, and renal alterations and dysfunction. Stratified analyses of HTN-related mortality in obese adults by demographic and geographic categorization are limited. In this study, we analyze these HTN-related mortality trends in obese adults aged 25 years and older in the United States from 1999 to 2023.
Methods:
Data from death certificates of adults aged ≥ 25 years from the CDC WONDER database from 1999 to 2023 were analyzed using ICD-10 codes related to HTN (I10-I15) as the underlying cause of death and obesity (E66) as a contributing cause of death. Results were stratified by year, along with demographic and regional classifications. Age-adjusted mortality rates (AAMR) were quantified per 100,000 persons by standardizing crude mortality rates (CMR) with 95% confidence intervals (95%CI). Annual percent change (APC) and average annual percent change (AAPC) were calculated using Joinpoint regression software. Statistical significance was set at P<0.05.
Results:
HTN-related mortality in obese adults caused a total of 82,079 deaths from 1999 to 2023, mainly in the decedent’s home (56.59%). Overall AAMR increased from 0.45 in 1999 to 2.75 in 2023 (AAPC: 7.24; 95%CI: 6.80 to 7.92). In terms of age groups, adults aged 55-64 years had the highest average CMR, while those aged 75-84 years had the highest rate of increase (AAPC: 9.20; 95%CI: 8.67 to 9.84). Men, in comparison to women, had higher average AAMR along with a higher rate of increase (AAPC: 8.38; 95%CI: 8.04 to 8.97). Racially, non-Hispanic (NH) Black/African Americans had the highest average AAMR, and NH Whites had the highest rate of increase (AAPC: 8.25; 95%CI: 8.01 to 8.70). The South had the highest average AAMR, and the Midwest had the highest rate of increase (AAPC: 8.60; 95%CI: 8.06 to 9.54). States in the top 90th percentile of deaths included California, Florida, New York, Ohio, and Texas. From 1999 to 2020, urban areas had higher average AAMR, though rural areas had a higher rate of increase (AAPC: 10.02; 95%CI: 9.52 to 10.72).
Conclusion:
HTN-related mortality in obese adults aged 25 and older has increased from 1999 to 2023, with marked demographic and geographic disparities. Increased focus on obesity awareness and management is crucial to lessen future mortality, especially in at-risk groups.