Associations of cardiovascular–kidney–metabolic syndrome stages with premature mortality and the role of social determinants of health
Objectives: The American Heart Association defined cardiovascular–kidney–metabolic (CKM) syndrome as a novel multi-stage disorder. We examined the associations of CKM stages with premature mortality and the role of social determinants of health (SDOHs). Design: A prospective cohort study. Setting an...
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Elsevier
2025-04-01
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| Series: | The Journal of Nutrition, Health and Aging |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1279770725000272 |
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| author | Ruixin Zhu Ran Wang Jingjing He Langrun Wang Huiyu Chen Yifan Wang Peng An Keji Li Fazheng Ren Weili Xu J. Alfredo Martinez Anne Raben Jie Guo |
| author_facet | Ruixin Zhu Ran Wang Jingjing He Langrun Wang Huiyu Chen Yifan Wang Peng An Keji Li Fazheng Ren Weili Xu J. Alfredo Martinez Anne Raben Jie Guo |
| author_sort | Ruixin Zhu |
| collection | DOAJ |
| description | Objectives: The American Heart Association defined cardiovascular–kidney–metabolic (CKM) syndrome as a novel multi-stage disorder. We examined the associations of CKM stages with premature mortality and the role of social determinants of health (SDOHs). Design: A prospective cohort study. Setting and participants: A nationally representative sample of US adults from NHANES 1999–2018. Measurements: CKM included 5 stages (stages 0–4), reflecting progressive pathophysiology. Premature mortality (deaths before 75 years) were ascertained via linkage to the National Death Index with follow-up until 2019. Cox proportional-hazards models adjusted for age, sex, race/ethnicity, medical history, and other confounding factors were used to calculate the hazard ratios (HR) and 95% CIs for CKM-mortality associations. Results: Among 27,909 participants (mean age 49.7 years, 49.0% females), 1762 premature deaths occurred over a median follow-up of 8.3 years. Compared with stage 0, the adjusted HRs for all-cause premature mortality at CKM stages 1–4 were 0.88 (95% CI 0.66–1.17), 1.31 (0.99–1.73), 1.94 (1.31–2.87), and 2.19 (1.61–2.98), respectively. For CVD premature mortality, the adjusted HRs for CKM stages 1–4 were 1.12 (0.46–2.72), 1.74 (0.71–4.28), 3.93 (1.53–10.12), and 6.48 (2.95–14.20), respectively. Among adults at CKM stages 3–4, unfavorable SDOHs, particularly not living with a partner, low family income, lack of private health insurance, unemployment, or ≥2 cumulative SDOHs (4.16, 95% CI 3.35–5.18) were associated with increased all-cause premature mortality. Among those at CKM stages 0–2, unfavorable SDOHs were also related to increased premature mortality. Conclusion: CKM stages 3–4, but not stages 1–2, were associated with increased risks of premature mortality compared with stage 0. The risks were increased by unfavorable SDOHs across CKM stages. |
| format | Article |
| id | doaj-art-13575fb7cdb84fd8b5f29cf1d00f70dd |
| institution | OA Journals |
| issn | 1760-4788 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Elsevier |
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| series | The Journal of Nutrition, Health and Aging |
| spelling | doaj-art-13575fb7cdb84fd8b5f29cf1d00f70dd2025-08-20T02:10:13ZengElsevierThe Journal of Nutrition, Health and Aging1760-47882025-04-0129410050410.1016/j.jnha.2025.100504Associations of cardiovascular–kidney–metabolic syndrome stages with premature mortality and the role of social determinants of healthRuixin Zhu0Ran Wang1Jingjing He2Langrun Wang3Huiyu Chen4Yifan Wang5Peng An6Keji Li7Fazheng Ren8Weili Xu9J. Alfredo Martinez10Anne Raben11Jie Guo12Key Laboratory of Precision Nutrition and Food Quality, Department of Nutrition and Health, China Agricultural University, Beijing, ChinaKey Laboratory of Precision Nutrition and Food Quality, Department of Nutrition and Health, China Agricultural University, Beijing, ChinaKey Laboratory of Precision Nutrition and Food Quality, Department of Nutrition and Health, China Agricultural University, Beijing, ChinaKey Laboratory of Precision Nutrition and Food Quality, Department of Nutrition and Health, China Agricultural University, Beijing, ChinaKey Laboratory of Precision Nutrition and Food Quality, Department of Nutrition and Health, China Agricultural University, Beijing, ChinaKey Laboratory of Precision Nutrition and Food Quality, Department of Nutrition and Health, China Agricultural University, Beijing, ChinaKey Laboratory of Precision Nutrition and Food Quality, Department of Nutrition and Health, China Agricultural University, Beijing, ChinaDepartment of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing, ChinaKey Laboratory of Precision Nutrition and Food Quality, Department of Nutrition and Health, China Agricultural University, Beijing, ChinaDepartment of Neurobiology, Care Sciences & Society, Karolinska Institutet, Solna, SwedenCentro de Investigacion Biomedica en Red Area de Fisiologia de la Obesidad y la Nutricion (CIBEROBN), Madrid, Spain; Precision Nutrition and Cardiometabolic Health Program, IMDEA-Food Institute (Madrid Institute for Advanced Studies), CEI UAM + CSIC, Madrid, Spain; Department of Medicine and Endocrinology, University of Valladolid, Valladolid, SpainDepartment of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark; Department for Clinical and Translational Research, Copenhagen University Hospital — Steno Diabetes Center Copenhagen, Herlev, DenmarkKey Laboratory of Precision Nutrition and Food Quality, Department of Nutrition and Health, China Agricultural University, Beijing, China; Department of Neurobiology, Care Sciences & Society, Karolinska Institutet, Solna, Sweden; Corresponding author at: Key Laboratory of Precision Nutrition and Food Quality, Department of Nutrition and Health, China Agricultural University, No.10 Tianxiu Road, Haidian District, 100193 Beijing, China.Objectives: The American Heart Association defined cardiovascular–kidney–metabolic (CKM) syndrome as a novel multi-stage disorder. We examined the associations of CKM stages with premature mortality and the role of social determinants of health (SDOHs). Design: A prospective cohort study. Setting and participants: A nationally representative sample of US adults from NHANES 1999–2018. Measurements: CKM included 5 stages (stages 0–4), reflecting progressive pathophysiology. Premature mortality (deaths before 75 years) were ascertained via linkage to the National Death Index with follow-up until 2019. Cox proportional-hazards models adjusted for age, sex, race/ethnicity, medical history, and other confounding factors were used to calculate the hazard ratios (HR) and 95% CIs for CKM-mortality associations. Results: Among 27,909 participants (mean age 49.7 years, 49.0% females), 1762 premature deaths occurred over a median follow-up of 8.3 years. Compared with stage 0, the adjusted HRs for all-cause premature mortality at CKM stages 1–4 were 0.88 (95% CI 0.66–1.17), 1.31 (0.99–1.73), 1.94 (1.31–2.87), and 2.19 (1.61–2.98), respectively. For CVD premature mortality, the adjusted HRs for CKM stages 1–4 were 1.12 (0.46–2.72), 1.74 (0.71–4.28), 3.93 (1.53–10.12), and 6.48 (2.95–14.20), respectively. Among adults at CKM stages 3–4, unfavorable SDOHs, particularly not living with a partner, low family income, lack of private health insurance, unemployment, or ≥2 cumulative SDOHs (4.16, 95% CI 3.35–5.18) were associated with increased all-cause premature mortality. Among those at CKM stages 0–2, unfavorable SDOHs were also related to increased premature mortality. Conclusion: CKM stages 3–4, but not stages 1–2, were associated with increased risks of premature mortality compared with stage 0. The risks were increased by unfavorable SDOHs across CKM stages.http://www.sciencedirect.com/science/article/pii/S1279770725000272Cardiovascular–kidney–metabolic healthCardiovascular diseaseDiabetesObesityHealth disparities |
| spellingShingle | Ruixin Zhu Ran Wang Jingjing He Langrun Wang Huiyu Chen Yifan Wang Peng An Keji Li Fazheng Ren Weili Xu J. Alfredo Martinez Anne Raben Jie Guo Associations of cardiovascular–kidney–metabolic syndrome stages with premature mortality and the role of social determinants of health The Journal of Nutrition, Health and Aging Cardiovascular–kidney–metabolic health Cardiovascular disease Diabetes Obesity Health disparities |
| title | Associations of cardiovascular–kidney–metabolic syndrome stages with premature mortality and the role of social determinants of health |
| title_full | Associations of cardiovascular–kidney–metabolic syndrome stages with premature mortality and the role of social determinants of health |
| title_fullStr | Associations of cardiovascular–kidney–metabolic syndrome stages with premature mortality and the role of social determinants of health |
| title_full_unstemmed | Associations of cardiovascular–kidney–metabolic syndrome stages with premature mortality and the role of social determinants of health |
| title_short | Associations of cardiovascular–kidney–metabolic syndrome stages with premature mortality and the role of social determinants of health |
| title_sort | associations of cardiovascular kidney metabolic syndrome stages with premature mortality and the role of social determinants of health |
| topic | Cardiovascular–kidney–metabolic health Cardiovascular disease Diabetes Obesity Health disparities |
| url | http://www.sciencedirect.com/science/article/pii/S1279770725000272 |
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