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

Authors

Antoinette Cotton, Case Western Reserve UniversityFollow
Pedro RVO Salerno, Case Western Reserve University
Salil V. Deo, Case Western Reserve UniversityFollow
Ian Neeland, Case Western Reserve UniversityFollow
Sanjay Rajagopalan, Case Western Reserve UniversityFollow
Sadeer G. Al-Kindi, Case Western Reserve UniversityFollow
Yakov E. Elgudin, Case Western Reserve UniversityFollow

Document Type

Article

Publication Date

1-21-2025

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.

Keywords

cardiometabolic health, cardiovascular disease, diabetes, kidney disease, obesity, renal failure

Language

English

Publication Title

American Journal of the Medical Sciences

Rights

© 2025 The Author(s). This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/BY-NC-ND/4.0/), which permits non-commercial copying and redistribution of the material in any medium or format, provided the original work is not changed in any way and is properly cited.

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.

Recommended Citation

Cotton, Antoinette; Salerno, Pedro RVO; Deo, Salil V.; Neeland, Ian; Rajagopalan, Sanjay; Al-Kindi, Sadeer G.; and Elgudin, Yakov E., "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" (2025). Faculty Scholarship. 1255.
https://commons.case.edu/facultyworks/1255