Introduction: Obesity prevalence is higher in US rural vs nonrural counties. The objective was to evaluate trends in obesity-related mortality by rurality.
Method: We used CDC WONDER data, 2000−2019, on obesity as a multiple cause of death (ie, top 20 contributor) among US residents aged ≥25 years. County rurality was based on 6 levels: large central metro (urban) to noncore (rural). We obtained annual rates of obesity mortality/100 000 persons (AOM) and reported AOM fold change (2018-2019 vs 2000-2001) and annual percent change (APC) based on linear regression of log(rates).
Result: The AOM increased across all rurality levels (Figure). The AOM fold change (APC) ranged from 2.4 (4.9%) in large central metro to 2.9 (6.0%) in noncore, with 22% higher APC in noncore vs large central metro counties. Furthermore, in noncore vs large central metro counties, the APC was 13.8% higher in men and 33.6% higher in women. In noncore vs large central metro counties, the APC was 40.8% higher in the 25-54 age group, 24.6% higher in the 55-74 age group, but 4.8% lower in the ≥75 age group. In noncore vs large central metro counties by region, the APC was 41.9% higher (West), 15.8% higher (South), 9.4% higher (Midwest), and 1.4% lower (Northeast).
Conclusion: In US adults, obesity-related mortality increased 2-3 fold with higher rates in noncore counties, with additional disparity by gender, age, and region. The increasing mortality and persistent disparities require evaluation.
B.T. Varghese: None. M. Mielke: Consultant; Biogen. Advisory Panel; Eisai Inc., Merck & Co., Inc. Consultant; Eli Lilly and Company. Advisory Panel; Roche Diagnostics. A. Vella: Research Support; Novo Nordisk. Consultant; Hanmi Pharm. Co., Ltd., Crinetics Pharmaceuticals, Inc. Advisory Panel; Rezolute, Inc. K.R. Bailey: None. S.B. Dugani: None.
National Institutes of Health (K23 MD106230)
