Rising U.S. mortality associated with coexisting obstructive sleep apnea and obesity, 1999-2019

Abstract

Background: Obstructive Sleep Apnea (OSA) and obesity are common health conditions in sleep medicine and nutrition sciences, respectively. The two conditions frequently co-exist and are likely to influence each other. While obesity is one among many factors that predispose individuals to OSA, OSA may also worsen metabolic health and contribute to weight gain. Their coexistence, therefore, may compound mortality risk. However, national mortality patterns among individuals with concomitantly occurring OSA and obesity remain underexplored.

Objective: To evaluate regional and demographic disparities in mortality among adults with coexisting OSA and obesity in the United States (U.S.) from 1999 to 2019.

Methods: This retrospective analysis used death certificate data from the US CDC WONDER database of adults ≥25 years with concomitantly occurring OSA and obesity. Age-adjusted mortality rates (AAMRs) per 100,000 population, annual percent change (APC), and average annual percent change (AAPC) were calculated through Joinpoint regression. We used ICD-10 codes for OSA (G47.3) and obesity (E66).

Results: Between 1999 and 2019, a total of 60,898 deaths were attributed to coexisting OSA and obesity, with an overall AAMR of 1.35. Notably, the AAMR increased from 1999 to 2005 (APC = 14.55; 95 % CI: 12.51 to 16.63), followed by a further increase from 2005 to 2013 (APC = 6.36; 95 % CI: 5.49 to 7.25), and finally increased until 2019 (APC: 3.43; 95 % CI: 2.5 to 4.36). Men had higher AAMRs than women (1.67 vs 1.05, respectively). Non-Hispanic (NH) African Americans had the highest AAMRs (1.99), followed by NH Whites (1.37) and Hispanics (0.84). Among different age groups, individuals aged 65+ had the highest AAMR (2.75). Geographically, the Midwest had the highest AAMR (1.56), followed by the West (1.55), South (1.29), and Northeast (0.99). Rural areas AAMRs (1.62) dominated the urban areas AAMRs (1.29).

Conclusions: An overall increasing trend in mortality was seen in adults with coexisting OSA and obesity in the US from 1999 to 2019, although these results may be affected by under-reporting of OSA on death certificates. Notable disparities in mortality were observed among NH African Americans, males over 65 years, and residents of rural and Midwestern regions. These rising mortality trends underscore the importance of timely recognition and clinical evaluation of individuals with co-occurring OSA and obesity. These findings further highlight the need for integrated obesity and sleep-health surveillance programs at the macro level. At the meso level, preventive screening measures for high-risk populations should be implemented. Early detection, lifestyle interventions, and adherence to the treatment should be prioritised at the micro level.