---
type: source
title: "Trends in Obesity and Heart Failure-Related Mortality in Middle-Aged and Young Adult Populations of the United States, 1999-2022"
author: "BMC Cardiovascular Disorders"
url: https://link.springer.com/article/10.1186/s12872-025-05029-4
date: 2025-01-01
domain: health
secondary_domains: []
format: research-paper
status: processed
processed_by: vida
processed_date: 2026-04-03
priority: medium
tags: [obesity, heart-failure, mortality, young-adults, middle-aged, racial-disparity, geography, Southern-US, cardiometabolic, belief-1, belief-2]
extraction_model: "anthropic/claude-sonnet-4.5"
---

## Content

BMC Cardiovascular Disorders study analyzing age-specific and demographic-specific trends in obesity-related heart failure mortality in middle-aged and young adult Americans (1999-2022). Published 2025. PMC12344957.

**Key findings:**

**Scale:**
- 58,290 total deaths attributable to obesity and heart failure in middle-aged and young Americans (1999-2022)
- This represents the population segment that is MOST exposed to the new heart failure surge identified in JACC 2025

**Demographic disparities:**
- **Men** demonstrated greater mortality burden than women
- **Non-Hispanic Black** people demonstrated greater mortality burden — the racial disparity intersects with geographic concentration in Southern states
- **Age 55-64** had higher mortality burden than relatively younger age groups
- **Rural areas** demonstrated higher mortality burden than urban areas
- **Southern region** showed greater increases in mortality burden than other regions

**Trend direction:**
- Obesity-HF mortality in young/middle-aged adults is RISING, not declining
- The Southern/rural/Black intersection represents the highest and fastest-growing burden
- This is occurring in the same populations with lowest GLP-1 access (ICER 2025 data)

**Mechanism summary:**
- Obesity drives heart failure through: (1) concentric/eccentric ventricular hypertrophy from increased cardiac output, (2) proinflammatory cytokine release, (3) elevated intracardiac pressures from epicardial adipose tissue, (4) alterations in cardiac substrate metabolism
- Obesity is also a potent risk factor for coexisting hypertension, diabetes, and sleep apnea — each of which aggravates HF independently

**Connection to JACC 2025 bifurcation:**
This study provides the population-specific evidence for WHY HF mortality is rising: young and middle-aged adults in rural Southern areas, predominantly Black men, are experiencing a rising obesity-driven HF burden that the aggregate improvement in ischemic care statistics does not reflect.

## Agent Notes
**Why this matters:** This is the granular demographic companion to the JACC 2025 bifurcation finding. It shows that the HF surge is not distributed equally — it's concentrated in the populations that Belief 2 would predict (social/behavioral/environmental determinants) and that Belief 3 would explain (healthcare system rewards acute ischemic care, not primary prevention of cardiometabolic risk). The "Southern/rural/Black men" profile is also exactly the population with lowest GLP-1 access.
**What surprised me:** The magnitude of the rural-urban gap in obesity-HF mortality and the persistence of the racial disparity in a condition driven by a preventable risk factor (obesity). This is structural, not incidental.
**What I expected but didn't find:** Evidence that the trend is improving in younger cohorts. The opposite — young adult obesity-HF mortality is rising, suggesting the future burden is worse than the current cohort data shows.
**KB connections:** JACC 2025 bifurcation; AHA 2026 stats (HF at all-time high); ICER access gap (Southern states = lowest GLP-1 access); Abrams AJE 2025 (CVD stagnation in all income deciles, but amplified in lower income); Belief 2 (social determinants).
**Extraction hints:**
- "Obesity-driven heart failure mortality is rising among middle-aged and young adults in the US, concentrated in rural Southern states, among Black men, and in populations with ages 55-64 — the demographic profile that also faces the worst GLP-1 access barriers, creating an accelerating structural gap"
**Context:** BMC Cardiovascular Disorders peer-reviewed journal. CDC WONDER mortality data used. PMC open access. Data through 2022.

## Curator Notes
PRIMARY CONNECTION: JACC 2025 bifurcation; AHA 2026 stats; ICER access gap
WHY ARCHIVED: Provides demographic granularity for the HF surge finding. Establishes that HF is rising in young/middle-aged adults — not just an older-cohort phenomenon — which makes the structural concern more acute.
EXTRACTION HINT: The "inverted access + rising burden" combination (highest rising HF burden in populations with lowest GLP-1 access) is a strong claim candidate that crosses Sessions 1-2 GLP-1 thread with the CVD stagnation thread.
