Trends and disparities in heart failure and heart failure with obesity mortality among U.S. adults: A 1999-2020 analysis of geographic, gender, and racial variations using CDC WONDER data.

Background: Heart failure (HF) is a leading cause of hospitalization and mortality, and it poses a significant burden on healthcare systems globally. Obesity is a considerable risk factor for HF and contributes to increased cardiac stress and metabolic demands.

Methods: Data from the CDC WONDER database were examined from 1999-2020 for HF and HF with obesity-related mortality in adults aged 25 years and older at the time of death, using ICD-10 codes. Age-adjusted mortality rates (AAMR) per million persons were calculated.

Results: From 1999 to 2020, the overall AAMR for HF-related deaths in adults declined from 1627 to 1544 (AAPC: -0.49, 95% CI: -0.63 to -0.34), whereas AAMR for HF and obesity rose steadily from 10.7 in 1999 to 42.1 in 2020 (AAPC: 6.23, 95% CI: 5.50 to 6.82). The overall HF-related AAMR for both genders decreased from 1999 to 2020, with a more significant decline in women. In contrast, HF and obesity-related AAMRs significantly increased for both genders, with a more pronounced rise in men. HF-related AAMRs decreased for Whites, Hispanic or Latinos, and Asian/Pacific Islanders but increased statistically insignificantly for Black/African Americans and American Indian/Alaska Natives. HF and obesity-related AAMRs increased across all races from 1999 to 2020, with an overall AAPC of 6.23. The highest HF-associated mortality and HF and obesity-related rates were observed in the Midwest.

Conclusion: Overall, a declining trend in HF-related mortality could be seen. However, the increasing HF-obesity mortality despite a general decrease in HF death is concerning.