Abstract Body: Introduction: Obesity and hypertension are interrelated conditions that significantly elevate cardiovascular risk and mortality. This study examines national trends and disparities in mortality involving both conditions among U.S. adults from 1999 to 2020, with emphasis on geographic, sex, and racial/ethnic differences.

Hypothesis: We hypothesized that mortality from obesity and coexistent hypertension has changed over time and that significant disparities exist by race, ethnicity, sex, and geographic region in the United States (US) from 1999 to 2020.

Methods: We conducted a retrospective analysis of US death certificate data from the CDC WONDER database. Adults aged ≥25 years with both obesity (ICD-10 code: E66) and hypertension (CD-10 code: I10–I15) listed as causes of death between 1999 and 2020 were included. Age-adjusted mortality rates (AAMRs) per 100,000 were calculated and stratified by sex, race/ethnicity, census region, urbanization, and state. Joinpoint regression was used to estimate annual percent change (APC) and average annual percent change (AAPC), with 95% confidence intervals (CIs).

Results:
Between 1999 and 2020, obesity-associated hypertension was responsible for 293,774 deaths among adults aged 25 and older in the US. The AAMR increased from 1.32 in 1999 to 14.70 in 2020 (AAPC: +8.53; 95% CI: 6.99–10.09; p < 0.000001). Men had higher AAMRs (7.14) compared to women (5.22), with a more pronounced increase in men (AAPC: +9.44, p < 0.000001) than in women (AAPC: +7.48, p < 0.000001).). Racial/ethnic disparities revealed non-Hispanic (NH) Blacks had the highest AAMR (12.2), followed by NH American Indian/Alaska Natives (9.6), NH Whites (5.7), Hispanics (4.9), and NH Asians/Pacific Islanders (1.4). Geographically, AAMRs ranged from 15.1 in Vermont to 3.2 in Connecticut, with the Southern region showing highest mortality (AAMR: 6.6). Nonmetropolitan areas had slight higher AAMRs (6.8) than metropolitan areas (6.0).

Conclusions: Mortality involving obesity and hypertension has increased substantially in the U.S. from 1999 to 2020.
Men, NH Black individuals, and people in Southern and nonmetropolitan regions observed the highest mortality among different demographic categories. These results highlight the need for deeper investigation and targeted public health interventions to address these disparities and improve health outcomes.