How Obesity Shapes Public Concern and Complication Risks Across the U.S.
- States with higher obesity rates have much greater search interest in “epidural headache” (correlation r = 0.627, p < 0.001).
- West Virginia has the highest risk score at 93.5, indicating the greatest combined risk factors among all states.
- The District of Columbia has the lowest risk score at 16.6, reflecting the lowest combined risk factors in the analysis.
Epidural Headache
A new study by RIVANNA examines the relationship between epidural anesthesia utilization rates, obesity prevalence, and public interest in epidural-related complications across U.S. states. By analyzing these three interconnected health indicators, we aim to identify patterns that may inform healthcare policy and risk assessment.
Although results are conflicting, moderate evidence suggests that patients with higher BMI may have a lower incidence of post-dural puncture headache (PDPH) after inadvertent dural puncture; findings show that states with higher obesity rates are more likely to search for information about epidural headaches. Importantly, patients with higher BMI also face higher overall complication rates with neuraxial procedures, including increased technical difficulty, risk of failed attempts, and other adverse outcomes, which further contribute to the heightened risk profile in these states.
“Even though medical literature shows a lower incidence of epidural headaches in obese patients, perception often trumps data. Patients worry about what they experience and hear about anecdotally—and those concerns show up clearly in search patterns.” – Dr. Stephen Garber, Anesthesiologist, California.
Growing Interest
There is very limited data on post-dural-puncture headache, an epidural complication, commonly referred to as “epidural headache.” Our research showed that interest in this condition grew steadily over the past 20 years.
Search interest in “epidural headache” was almost nonexistent in 2004 but rose sharply—especially between 2011 and 2018—reaching an average of 41.9 by 2019–2025. The highest point, in 2025 (46.7), is a 38-point increase from 2005, showing that “epidural headache” has gone from a rarely searched topic to a significant public health concern.
What We Measured
- Epidural Use: The percentage of births where an epidural or spinal anesthesia was used. This ranged from 44.3% in Alaska to 87.3% in Alabama, with an average of 73.5%.
- Obesity Rates: The percentage of adults with obesity (BMI of 30 or more). This ranged from 23.5% in the District of Columbia to 41.2% in West Virginia.
- Search Interest: How often people searched for “epidural headache” on Google, measured on a scale from 0 to 100. West Virginia had the highest interest (100).
What We Found
- Obesity and Search Interest: There is a strong connection States with higher obesity rates have much more search interest in “epidural headache.” This suggests people in these states may experience or worry about epidural side effects more.
- Epidural Use and Search Interest: There is no connection between how often epidurals are used and how much people search for epidural headaches.
State Risk Rankings
Using all three variables, we ranked states by risk score:
Highest Risk (Top 5)
- West Virginia (93.5 risk score)
- Alabama (85.1 risk score)
- Oklahoma (78.8 risk score)
- Tennessee (75.9 risk score)
- Arkansas (74.38 risk score)
Lowest Risk (Bottom 5)
- District of Columbia (16.6 risk score)
- Vermont (18.0 risk score)
- California (23.6 risk score)
- Maine (24.2 risk score)
- Hawaii (25.7 risk score)
Key Findings
- Significant Obesity-Search Interest Connection: The strongest finding is the positive correlation (r = 0.627) between obesity prevalence and search interest in epidural headaches, suggesting that populations with higher obesity rates are more concerned about epidural complications.
- Regional Risk Patterns: Southern and Midwestern states dominate the high-risk categories, while coastal states and the District of Columbia show lower composite risk scores.
- West Virginia as Outlier: West Virginia shows the highest composite risk score (93.5), combining high obesity (41.2%), high epidural use (78.9%), and maximum search interest (100).
Comprehensive State Data Table
Methodology
Data Source
- Epidural Use Rates (2016)
- Source: CDC National Center for Health Statistics (NCHS)
- Measurement: Percentage of births involving epidural or spinal anesthesia by state
- Range: 44.3% (Alaska) to 87.3% (Alabama)
- National Average: 73.5%
- Obesity Prevalence
- Source: CDC State-level obesity prevalence data with 95% confidence intervals
- Measurement: Percentage of adult population with BMI ≥30
- Range: 23.5% (District of Columbia) to 41.2% (West Virginia)
- National patterns reflect regional health disparities
- Search Interest for “Epidural Headache”
- Source: Google Trends data (January 2004 – June 2025)
- Measurement: Relative search volume on a 0-100 scale
- Range: 40 (lowest interest) to 100 (highest interest – West Virginia)
- Indicates public concern about epidural complications
Statistical Analysis:
- Pearson correlation coefficients calculated for all variable pairs
- P-values computed to assess statistical significance (α = 0.05)
- Spearman rank correlation analysis performed to verify findings
Risk Score Calculation:
- Each variable normalized to a 0-100 scale
- Composite risk score = (Epidural Risk + Obesity Risk + Search Risk) / 3
- States ranked and categorized into five risk levels
Limitations:
- Two states (Pennsylvania, Kentucky) missing obesity data
- Google Trends data represents relative, not absolute, search volumes
- Temporal mismatch between datasets (epidural data from 2016, search data through 2025)
- Correlation does not imply causation
Sample Size: 49 states with complete data, 51 total jurisdictions analyzed
Correlations
Our analysis of 49 states with complete data revealed the following correlations:
- Epidural Use Rate vs Obesity Prevalence
- Pearson correlation: r = 0.040, p = 0.785
- Result: Very weak positive correlation, NOT statistically significant
- Interpretation: No meaningful relationship between epidural use and obesity rates
- Epidural Use Rate vs Search Interest
- Pearson correlation: r = 0.167, p = 0.251
- Result: Very weak positive correlation, NOT statistically significant
- Interpretation: Higher epidural use does not predict higher search interest in complications
- Obesity Prevalence vs Search Interest
- Pearson correlation: r = 0.627, p < 0.001
- Result: Moderate positive correlation, HIGHLY statistically significant
- Interpretation: States with higher obesity rates show significantly more interest in epidural headache searches