Prevalence, Disparities, and Mortality of Cardiovascular-Kidney-Metabolic Syndrome in US Adults, 2011-2018

Abstract

Background: Cardiovascular-kidney-metabolic syndrome reflects the complex interplay between metabolic risk factors, cardiovascular and chronic kidney disease. Differences in disease burden by demographics, social determinants of health, and mortality are not well characterized.

Methods: Data from adults who completed the National Health and Nutrition Examination Survey between 2011 and 2018 were used to estimate age-adjusted prevalence and 95% confidence intervals (CI) for cardiovascular-kidney-metabolic syndrome stages. Joinpoint regression was used to identify linear trends. Kaplan-Meier curves were used to examine all-cause mortality risk by stages.

Results: Among 8474 adults in the study, the median age was 46.8 years, 49.1% were male, and 65.0% were non-Hispanic White. Age-adjusted prevalence of stages 0-4 were 11.2%, 28.1%, 47.4%, 5.3%, and 8.1%, respectively. The highest proportion of stage 4 was among adults aged ≥60 years, males, and non-Hispanic Black individuals. The advanced stages 3-4 were associated with lower educational attainment, income, and employment and higher mortality with a crude death rate of 188.8 per 1000 person-years.

Conclusion: Approximately 13% of adults were in advanced stages, which disproportionately affect non-Hispanic Black adults and increased over time. These results provide a roadmap for targeted intervention strategies.

Keywords: Cardiovascular disease; Cardiovascular-kidney-metabolic syndrome; Chronic kidney disease; Metabolic syndrome; Mortality.

Figure 1.

Age-adjusted prevalence of Cardiovascular-Kidney-Metabolic syndrome stages for overall and strata by age, gender and race/ethnicity; Age-adjusted prevalence was estimated for overall, and stratified by gender and race/ethnicity using the 2000 US. Bar segments are ordered from left to right to indicate stages 0 to 4, including overall prevalence and stratification by key demographics. It shows that approximately 13% of the US population is in the advanced stages (stages 3 and 4).

Figure 2.

Age-adjusted prevalence of Cardiovascular-Kidney-Metabolic syndrome by social determinants of health among US adults, NHANES 2011-2018. Bar segments are ordered from left to right to indicate stages 0 to 4, with stratification by social determinants of health. Adults with adverse social determinants of health were are more likely to be in advanced Cardiovascular-Kidney-Metabolic syndrome stages 3 and 4.

Figure 3.

Kaplan-Meier curves for Cardiovascular-Kidney-Metabolic syndrome and all-cause mortality in US adults. The survival curves, arranged from top to bottom, represent the probability of survival over time. Each curve steps downward at each event, indicating a decrease in survival probability. (A) The advanced stages 3-4 indicate a higher all-cause mortality risk compared to the earlier stages. (B) As the number of components increases, a higher all-cause mortality risk is observed.