Emerging trends and disparities in cardiovascular, kidney, and diabetes-related mortality: A retrospective analysis of the wide-ranging online data for epidemiologic research database

Aman Goyal, Humza Saeed, Samia Aziz Sulaiman, Wania Sultan, Momina Riaz Siddiqui, Mah I. Kan Changez, Arman Qamar, Sarju Ganatra, Sourbha S. Dani

Abstract

Cardiovascular-kidney-metabolic (CKM) syndrome, driven by metabolic risk factors like obesity, type 2 diabetes (DM-2), chronic kidney disease (CKD), and cardiovascular disease (CVD), leads to poorer health outcomes. Despite its rising prevalence and promising new therapies, trends and demographic disparities in CKM-related mortality among adults in the United States remain underexplored.

Introduction

The interrelationship between cardiovascular disease (CVD), chronic kidney disease (CKD), obesity, and type 2 diabetes (T2DM) is well-established through complex pathophysiological mechanisms, often referred to as the cardiovascular-kidney-metabolic (CKM) syndrome [1]. These conditions share common risk factors, such as obesity, hypertension, and dyslipidemia, which exacerbate each other’s progression.

Materials & Methods

We used mortality data extracted on October 10, 2024 from the Centers for Disease Control and Prevention’s WONDER (Wide-Ranging Online Data for Epidemiologic Research) database. We investigated mortality rates among adults with CKM syndrome between 1999 and 2022 (for overall AAMR and up to 2020 for further stratification). We focused on the Multiple Cause-of-Death Public Use Record database to identify cases where acute CVD was listed as the underlying cause and both T2DM and CKD were listed as the contributing causes on death certificates across the United States.

Results

Between 1999 and 2022, there were 25,980 CKM syndrome-related deaths among adult patients in the United States. The place of death was recorded for 24,797 cases: 50.13% occurred in medical facilities, 20.9% in decedents’ homes, 22.5% in nursing homes or long-term care facilities, and 1.9% in hospices.

Discussion

Our findings demonstrate that between 1999 and 2022, CKM-related deaths among United States adults totaled 25,980, with 50% occurring in medical facilities. Following a significant increase in the AAMR from 1999 to 2012 (APC: 7.03; p<0.001), a significant decrease from 2012 to 2015 (APC: -65.55; p<0.001), and a non-significant increase since 2015 (APC: 15.98; p=0.101), the AAMR for CKM has significantly reduced from 5.3 per million in 1999 to 0.4 in 2022.

Conclusion

With the recent recognition of CKM as a distinct syndrome in 2023, our study highlights important trends and disparities in mortality among these patients in the United States. A concerning deceleration in the decline of mortality is evident, with men, older adults, NH American Indian/Alaska Native individuals, followed by Black adults, facing the highest risk. Geographic disparities are also prominent, with rural and Midwestern areas being most affected. These findings emphasize the urgent need for public health action and targeted interventions to reduce disparities.

Citation: Goyal A, Saeed H, Sulaiman SA, Sultan W, Siddiqui MR, Kan Changez MI, et al. (2025) Emerging trends and disparities in cardiovascular, kidney, and diabetes-related mortality: A retrospective analysis of the wide-ranging online data for epidemiologic research database. PLoS One 20(5): e0320670. https://doi.org/10.1371/journal.pone.0320670

Editor: Anukul Ghimire, University of Calgary, CANADA

Received: November 21, 2024; Accepted: February 22, 2025; Published: May 5, 2025

Copyright: © 2025 Goyal et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: The data used in this study were obtained from the CDC Wonder database (https://wonder.cdc.gov/). Raw data and detailed instructions with search terms required to replicate the data extraction process are provided in the “figshare” repository at DOI: https://doi.org/10.6084/m9.figshare.28236344.v1 . No special access privileges were required to access the data, and all interested researchers can replicate our study findings using the information provided.

Funding: The author(s) received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.

Abbreviations: APC, Annual percentage change; AAMR, Age-adjusted mortality rates; NH, Non-Hispanic; CKM, Cardiovascular-kidney-metabolic; DM, Type 2 Diabetes Mellitus; CVD, Cardiovascular disease; CKD, Chronic kidney disease