Abstract 25: The Impact of Excess Body Weight on Cardiovascular Disease Mortality From 1990 to 2015 and Drivers of Change at the State-Level in the United States

Abstract

Introduction: Maintaining a healthy weight is a key step toward ideal cardiovascular health and achieving AHA 2020 goals. State-level estimates of excess body weight and its impact on cardiovascular disease (CVD) mortality are necessary to inform interventions and track progress. Objective: To systematically quantify CVD deaths attributable to high body mass index (BMI) by age, sex, and state between 1990 and 2015. Methods: We synthesized 118 surveys (12,972,378 person-years) to characterize the population distribution of BMI by age, sex, and state from 1990-2015. We used a hierarchical mixed-effects linear regression to quantify and adjust for bias in self-reported height and weight data. Using the Global Burden of Disease analytic framework, we estimated CVD deaths attributable to high BMI in five-year increments from 1990 to 2015. We also quantified the contribution of changes in population structure, background mortality rate, and risk exposure to overall changes in CVD mortality. Results: In 2015, 173,180 (95% uncertainty interval: 130,890-218,620) CVD deaths were attributable to high BMI in the US: 70.4% from ischemic heart disease, 11.6% from hypertensive heart disease, 9.7% from hemorrhagic stroke and 8.2% from ischemic stroke. Mississippi had the highest attributable death rate (65.6 per 100,000 [51.6-80.3]), whereas Colorado had the lowest (23.4 [17.1-30.6]) (Figure). While the prevalence of excess body weight increased in all states from 1990-2015, reductions in background mortality rate offset increases in risk exposure (Figure). As a result, over the past 25 years the death rate attributable to high BMI increased in only 3 states (annual percent change: OK [0.53%], AL [0.17%], AK [0.08%]). The 3 states with the greatest annual decrease in attributable death rate were MN (-1.52%), NH (-1.47%), and MA (-1.45%). Conclusions: Our results highlight the need for implementation of evidence-based interventions at the state-level to reduce the prevalence and disease burden of high BMI in order to meet AHA 2020 goals.