Abstract
BackgroundIn recent years, there have been adverse trends in premature cardiovascular disease (CVD) mortality rates (35–74 years) in the USA and Australia. Following long-term declines, rates in the USA are now increasing while falls in Australia have slowed rapidly. These two countries also have the highest adult obesity prevalence of high-income countries. This study investigates the role of overweight and obesity in their recent CVD mortality trends by using multiple cause of death (MCOD) data—direct individual-level evidence from death certificates—and linking the findings to cohort lifetime obesity prevalence.MethodsWe identified overweight- and obesity-related mortality as any CVD reported on the death certificate (CVD MCOD) with one or more of diabetes, chronic kidney disease, obesity, lipidemias or hypertensive heart disease (DKOLH-CVD), causes strongly associated with overweight and obesity. DKOLH-CVD comprises 50% of US and 40% of Australian CVD MCOD mortality. Trends in premature age-standardized death rates were compared between DKOLH-CVD and other CVD MCOD deaths (non-DKOLH-CVD). Deaths from 2000 to 2017 in the USA and 2006–2016 in Australia were analyzed. Trends in in age-specific DKOLH-CVD death rates were related to cohort relative lifetime obesity prevalence.ResultsEach country’s DKOLH-CVD mortality rate rose by 3% per annum in the most recent year, but previous declines had reversed more rapidly in Australia. Non-DKOLH-CVD mortality in the USA increased in 2017 after declining strongly in the early 2000s, but in Australia it has continued declining in stark contrast to DKOLH-CVD. There were larger increases in DKOLH-CVD mortality rates at successively younger ages, strongly related with higher relative lifetime obesity prevalence in younger cohorts.ConclusionsThe increase in DKOLH-CVD mortality in each country suggests that overweight and obesity has likely been a key driver of the recent slowdown or reversal of CVD mortality decline in both countries. The larger recent increases in DKOLH-CVD mortality and higher lifetime obesity prevalence in younger age groups are very concerning and are likely to adversely impact CVD mortality trends and hence life expectancy in future. MCOD data is a valuable but underutilized source of data to track important mortality trends.
Highlights
In recent years, there have been adverse trends in premature cardiovascular disease (CVD) mortality rates (35–74 years) in the USA and Australia
In Australia, male CVD underlying cause of death (UCOD) and multiple cause of death (MCOD) mortality rates at all ages were both declining at about 1% per annum in 2016, slightly slower than for females
Our study reveals that premature CVD mortality from overweight- and obesity-related causes—which we have defined as DKOLH-CVD—is rising at an increasing rate in Australia and the USA, reaching 3% per annum in recent years for both males and females, faster than nonDKOLH-CVD causes
Summary
There have been adverse trends in premature cardiovascular disease (CVD) mortality rates (35–74 years) in the USA and Australia. The latest annual decline in death rates across high-income countries is about half that observed in the first decade of this century These trends are concerning given that life expectancy improvements in some highincome countries are slowing or have even stalled and that continuing large declines in CVD, as a leading cause of death, would be a major contributor to future gains in life expectancy [2,3,4,5]. These trends in CVD mortality are occurring concurrently with, or soon after, adverse trends in overweight and obesity in many high-income countries. While CVD mortality trends are influenced by a range of other factors, such as smoking, blood pressure, and cholesterol, as well as the quality of and access to health care, its future direction will undoubtedly be influenced by the prevalence of overweight and obesity [11]
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