# National Trends in Cerebrovascular Disease–Related Mortality among Adults With Obesity in the United States, 1999–2020

## TL;DR

Cerebrovascular disease mortality among obese U.S. adults has risen sharply since 1999, with significant disparities by age, race, and location.

## Contribution

This study provides the first comprehensive analysis of long-term trends in cerebrovascular disease mortality among obese adults in the U.S.

## Key findings

- Cerebrovascular disease mortality among obese adults increased by 4.59% annually from 1999 to 2020.
- Mortality rates accelerated after 2008, with the fastest increases among younger adults and rural populations.
- American Indian/Alaska Native and Black adults had the highest mortality rates, while males showed steeper increases despite lower overall rates.

## Abstract

Cerebrovascular disease (CVD) remains a leading cause of death, with obesity exacerbating stroke risk through multiple metabolic pathways. However, long‐term trends in CVD‐related mortality among obese adults in the United States remain inadequately defined.

We analyzed national mortality data from 1999 to 2020 using the CDC WONDER database. Deaths were included if CVD (ICD‐10 I60–I69) was the underlying cause and obesity (E66) a contributing cause. Age‐adjusted mortality rates (AAMRs) were calculated, and temporal trends were evaluated using Joinpoint regression to estimate annual percent change (APC) and average annual percent change (AAPC).

From 1999 to 2020, 26,410 CVD‐related deaths occurred among obese adults. The overall AAMR was 0.53 per 100,000, with an AAPC of 4.59% (95% CI: 3.94 to 5.24). A statistically significant change in trend slope was observed after 2008, with accelerated mortality increases. Females had higher AAMRs (0.56) than males (0.49), though males experienced steeper increases (AAPC 5.98% vs. 3.64%). American Indian/Alaska Native and Black adults had the highest AAMRs (1.11 and 1.01, respectively). Mortality increased in all racial/ethnic groups, most rapidly among White individuals (AAPC 4.66%). Non‐metropolitan areas showed higher mortality than metropolitan areas (0.71 vs. 0.50), with a widening urban–rural gap. Regionally, the West and Midwest had the highest AAMRs (0.59 and 0.57, respectively). Mortality rose across all age groups, with the steepest increases in younger adults aged 25–54 years. Most deaths occurred in hospitals (56%), followed by home (22.8%) and nursing facilities (15.7%).

CVD‐related mortality among obese adults has increased significantly since 1999, with substantial disparities across sex, race, geography, and age, highlighting the need for focused public health strategies.

Using U.S. CDC WONDER mortality data from 1999–2020, cerebrovascular disease–related mortality among adults with obesity increased steadily, with acceleration after 2008. Pronounced disparities were observed by sex, race/ethnicity, geography, and age, with the fastest increases among younger adults.