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. 2025 Apr;369(4):491-497.
doi: 10.1016/j.amjms.2025.01.007. Epub 2025 Jan 21.

The association between county-level social determinants of health and cardio-kidney-metabolic disease attributed all-cause mortality in the US: A cross sectional analysis

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The association between county-level social determinants of health and cardio-kidney-metabolic disease attributed all-cause mortality in the US: A cross sectional analysis

Antoinette Cotton et al. Am J Med Sci. 2025 Apr.

Abstract

Background: The American Heart Association recently defined cardio-kidney-metabolic (CKM) syndrome as the intersection between metabolic, renal, and cardiovascular disease. Understanding the contemporary estimates of CKM related mortality in the US is essential for developing targeted public interventions.

Methods: We analyzed state-level and county-level CKM-associated all-cause mortality data (2010-2019) from the CDC Wide-ranging Online Data for Epidemiologic Research (WONDER). Median and interquartile (IQR) age-adjusted mortality rates (aaMR) per 100,000 were reported and linked with a multi-component metric for social deprivation: the Social Deprivation Index (SDI: range 0 - 100) grouped as: I: 0 - 25, II: 26 - 50, III: 51 - 75, and IV: 75 - 100. We fit pairwise comparisons between SDI groups and evaluated aaMR stratified by sex, race, and location.

Results: In 3101 counties, pooled aaMR was 505 (441-579). Oklahoma (643) and Massachusetts (364) had the highest and lowest values. aaMR increased across SDI groups [I: 454(404, 505), IV: 572(IQR: 495.9, 654.7); p < 0.001]. Men had higher rates [602 (526, 687)] than women [427 (368, 491)]. Metropolitan [476 (419, 542)] had lower rates than non-metropolitan counties [521 (454, 596)]. Non-Hispanic Black [637 (545, 731)] had higher rates than non-Hispanic White residents [497 (437, 570]. CKM associated aaMR remained reasonably constant between 2010 and 2019 (Mann Kendall test for trend p-value = 0.99).

Conclusions: In the US, CKM mortality disproportionately affects more socially deprived counties. Inability to reduce CKM mortality rates over the study period highlights the need for targeted policy interventions to curb the ongoing high burden.

Keywords: Cardiometabolic health; Cardiovascular disease; Diabetes; Kidney disease; Obesity; Renal failure.

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Conflict of interest statement

Declaration of competing interest Authors do not have any conflict of interest related to this study.

Figures

Fig. 1.
Fig. 1.. Map of the county level social deprivation index in the US.
In this map, we present the social deprivation index group for the US counties (3,101) included in our study.
Fig. 2.
Fig. 2.. County-level age adjusted all-cause mortality associated with cardio-kidney-metabolic syndrome in the US according to their social deprivation index group.
(A) This map demonstrates the median age adjusted all-cause mortality associated with cardio-kidney-metabolic syndrome per 100,000 residents in the studied US counties (3,101). (B) This boxplot reports the distribution of the county-level age adjusted all-cause mortality associated with cardio-kidney-metabolic syndrome per 100,000 residents for each social deprivation index group. Social deprivation index groups were divided according to the county-level social deprivation index as follows: Group I: SDI 0 – 25, Group II: SDI 26–50, Group III: SDI 51 – 75, Group IV: SDI 76–100.
Fig. 3.
Fig. 3.. County level age adjusted all-cause mortality associated with cardio-kidney-metabolic syndrome in the US in the studied subgroups.
This figure presents the distribution for the age adjusted all-cause mortality associated with cardio-kidney-metabolic syndrome in (A) men and women residents, (B) metropolitan and non-metropolitan counties, (C) according to race (non-Hispanic Black, non-Hispanic White, Hispanic, and other races), and (D) premature mortality, defined as the age of death < 65 years.

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