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

IF 2.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

American Journal of the Medical Sciences Pub Date : 2025-04-01 DOI:10.1016/j.amjms.2025.01.007

Antoinette Cotton BS,MBA , Pedro RVO Salerno MD , Salil V Deo MD , Salim S. Virani MD , Khurram Nasir MD , Ian Neeland MD , Sanjay Rajagopalan MD , Naveed Sattar MD , Sadeer Al-Kindi MD , Yakov E Elgudin MD,PhD

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引用次数: 0

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.

查看原文本刊更多论文

美国县级健康社会决定因素与心肾代谢性疾病全因死亡率之间的关系：一项横断面分析。

背景：美国心脏协会最近将心肾代谢（CKM）综合征定义为代谢、肾脏和心血管疾病的交叉点。了解美国CKM相关死亡率的当代估计对于制定有针对性的公共干预措施至关重要。方法：我们分析了来自疾病预防控制中心广泛在线流行病学研究数据（WONDER）的州一级和县级ckm相关全因死亡率数据（2010-2019）。报告了每10万人年龄调整死亡率（aaMR）的中位数和四分位数（IQR），并将其与社会剥夺的多成分指标联系起来：社会剥夺指数（SDI：范围0 - 100）分为：I: 0 - 25、II: 26 - 50、III: 51 - 75和IV: 75 - 100。我们拟合SDI组之间的两两比较，并评估按性别、种族和地区分层的aaMR。结果：3101个县的aaMR为505（441 ~ 579）。俄克拉荷马州（643）和马萨诸塞州（364）的数值最高和最低。SDI组aaMR升高[I: 454(404, 505), IV: 572(IQR: 495.9, 654.7)；P < 0.001]。男性的发病率[602(526,687)]高于女性[427(368,491)]。大都市区[476(419,542)]的发病率低于非大都市区[521(454,596)]。非西班牙裔黑人[637(545,731)]的发病率高于非西班牙裔白人[497(437,570)]。2010年至2019年间，CKM相关的aaMR保持相当稳定（Mann Kendall趋势p值检验 = 0.99）。结论：在美国，CKM死亡率不成比例地影响更多的社会贫困县。在研究期间无法降低慢性肾脏病死亡率，这突出表明需要有针对性的政策干预措施，以遏制目前的高负担。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Journal of the Medical Sciences 医学-医学：内科

CiteScore

4.40

自引率

0.00%

发文量

303

审稿时长

1.5 months

期刊介绍： The American Journal of The Medical Sciences (AJMS), founded in 1820, is the 2nd oldest medical journal in the United States. The AJMS is the official journal of the Southern Society for Clinical Investigation (SSCI). The SSCI is dedicated to the advancement of medical research and the exchange of knowledge, information and ideas. Its members are committed to mentoring future generations of medical investigators and promoting careers in academic medicine. The AJMS publishes, on a monthly basis, peer-reviewed articles in the field of internal medicine and its subspecialties, which include: Original clinical and basic science investigations Review articles Online Images in the Medical Sciences Special Features Include: Patient-Centered Focused Reviews History of Medicine The Science of Medical Education.