Cardiovascular-Kidney-Metabolic Syndrome-Attributable Mortality in the United States, From 2010 to 2023

BACKGROUND: Cardiovascular-kidney-metabolic syndrome (CKM) is increasingly prevalent in the United States, yet long-term nationwide data on CKM-attributable mortality remain limited. OBJECTIVES: This study analyzed CKM-attributable mortality trends in the United States from 2010 to 2019, focusing on sex, ethnoracial groups, urbanization, census region, and cardiovascular phenotype, with 2020-2023 data analyzed separately to specifically evaluate trends during and after the COVID-19 pandemic. METHODS: CKM-attributable mortality data were obtained from Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research using validated International Classification of Diseases-Tenth Revision codes. Age-adjusted mortality rates (AAMRs) and average annual percent change with 95% CIs were estimated via Joinpoint regression. Contributors to mortality, including controlled hypertension, obesity, physical inactivity, type 2 diabetes, and chronic kidney disease, were analyzed using World Health Organization noncommunicable disease (2010-2019), U.S. Diabetes Surveillance System (2010-2019), and U.S. Kidney Disease Surveillance System (2010-2020) data. RESULTS: From 2010 to 2019, CKM caused 3,354,032 deaths (AAMR 12,554/100,000), rising linearly (average annual percent change +0.7% [95% CI: 0.3%-1.1%]), especially in males, non-Hispanic Whites, <65-year-olds, rural residents, and Southerners. Non-Hispanic Black Americans had the highest AAMR. Hypertension was the most common CKM phenotype (30.1%), with increasing mortality in hypertensive, atrial fibrillation, and heart failure phenotypes, and decreasing in ischemic disease. Obesity, inactivity, and diabetes prevalence rose, controlled hypertension declined, and chronic kidney disease plateaued. From 2020 to 2023, CKM mortality plateaued across demographics. CONCLUSIONS: CKM-attributable mortality rose from 2010 to 2019 and plateaued from 2020 to 2023, contributing substantially to U.S. deaths with marked age, racial, and regional disparities. Awareness of these trends and targeted interventions may improve outcomes.