Abstract
Chronic obstructive pulmonary disease (COPD) and obesity are major US public health conditions that frequently coexist. Despite adverse respiratory and cardiometabolic effects of obesity, an apparent “obesity paradox,” whereby obesity has been associated with lower mortality in some patients with COPD, has been described. National mortality trends involving concurrent COPD and obesity remain poorly characterized. We examined temporal, demographic, and geographic patterns from 1999 to 2023. We conducted a retrospective, population-based analysis of the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research Multiple Cause of Death database. Deaths among adults aged ≥25 years listing COPD (International Classification of Diseases, 10th Revision: J40–J44) and obesity (International Classification of Diseases, 10th Revision: E66) were identified. Age-adjusted mortality rates per 100,000 were calculated using direct standardization to the 2000 US population. Joinpoint Regression Program version 5.3.0.0 estimated annual percent changes (APCs) and average annual percent changes with 95% confidence intervals (CIs). Analyses were stratified by age, sex, race/ethnicity, region, urbanization, and state. Among 1,30,958 deaths, the age-adjusted mortality rate increased from 0.78 (95% CI: 0.74–0.82) in 1999 to 2.63 (95% CI: 2.57–2.68) in 2023 (average annual percent change: +5.14%; 95% CI: 4.09–6.21;
P
< .001). After increasing significantly through 2013, mortality increased nonsignificantly during 2013 to 2018 (APC: +2.11%; 95% CI: −0.39 to 4.67), rose markedly during 2018 to 2021 (APC: +17.45%; 95% CI: 10.18–25.19), and declined significantly through 2023 (APC: −13.47%; 95% CI: −18.32 to −8.34). Males and adults aged ≥65 years had higher mortality burdens, with variation across racial/ethnic groups, urbanization levels, regions, and states. Interpretation is limited by unavailable individual-level factors, including smoking, COPD severity, comorbidities, and socioeconomic characteristics. Mortality involving concurrent COPD and obesity increased substantially from 1999 to 2023, with marked demographic and geographic variation and an increase during the COVID-19 pandemic. These population-level associations do not establish causality. Integrated pulmonary and metabolic care, targeted prevention, and improved access in underserved communities may help address observed disparities.