Heart Disease Phenomics Laboratory, Epidemiology and Community Health Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America.
Chronic Kidney Disease Section, Phoenix Epidemiology & Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, Arizona, United States of America.
PLoS One. 2024 May 29;19(5):e0302203. doi: 10.1371/journal.pone.0302203. eCollection 2024.
Heart failure (HF) and kidney disease frequently co-occur, increasing mortality risk. The cardiorenal syndrome results from damage to either the heart or kidney impacting the other organ. The epidemiology of cardiorenal syndrome among the general population is incompletely characterized and despite shared risk factors with HF, differences in mortality risk across key demographics have not been well described. Thus, the primary goal of this study was to analyze annual trends in cardiorenal-related mortality, evaluate if these trends differed by age, sex, and race or ethnicity, and describe these trends against a backdrop of HF mortality.
The Centers for Disease Control and Prevention Wide-ranging ONline Data for Epidemiologic Research database was used to examine cardiorenal- and HF-related mortality in the US between 2011and 2020. International Classification of Diseases, 10 Revision codes were used to classify cardiorenal-related deaths (I13.x) and HF-related deaths (I11.0, I13.0, I13.2, and I50.x), among decedents aged 15 years or older. Decedents were further stratified by age group, sex, race, or ethnicity. Crude and age-adjusted mortality rates (AAMR) per 100,000 persons were calculated. A total of 97,135 cardiorenal-related deaths and 3,453,655 HF-related deaths occurred. Cardiorenal-related mortality (AAMR, 3.26; 95% CI: 3.23-3.28) was significantly lower than HF-related mortality (AAMR, 115.7; 95% CI: 115.6-115.8). The annual percent change (APC) was greater and increased over time for cardiorenal-related mortality (2011-2015: APC, 7.1%; 95% CI: 0.7-13.9%; 2015-2020: APC, 19.7%, 95% CI: 16.3-23.2%), whereas HF-related mortality also increased over that time period, but at a consistently lower rate (2011-2020: APC, 2.4%; 95% CI: 1.7-3.1%). Mortality was highest among older and male decedents for both causes. Cardiorenal-related deaths were more common in non-Hispanic or Latino Blacks compared to Whites, but similar rates were observed for HF-related mortality. A larger proportion of cardiorenal-related deaths, compared to HF-related deaths, listed cardiorenal syndrome as the underlying cause of death (67.0% vs. 1.2%).
HF-related deaths substantially outnumber cardiorenal-related deaths; however, cardiorenal-related deaths are increasing at an alarming rate with the highest burden among non-Hispanic or Latino Blacks. Continued surveillance of cardiorenal-related mortality trends is critical and future studies that contain detailed biomarker and social determinants of health information are needed to identify mechanisms underlying differences in mortality trends.
心力衰竭 (HF) 和肾脏疾病经常同时发生，增加了死亡风险。心肾综合征是由于心脏或肾脏受损而影响另一个器官引起的。一般人群中心肾综合征的流行病学特征尚不完全清楚，尽管与 HF 有共同的危险因素，但关键人口统计学特征的死亡率风险差异尚未得到很好的描述。因此，本研究的主要目标是分析与心肾相关的死亡率的年度趋势，评估这些趋势是否因年龄、性别和种族或民族而不同，并在 HF 死亡率的背景下描述这些趋势。
本研究使用疾病控制和预防中心的广域在线数据流行病学研究数据库，检查了 2011 年至 2020 年美国与心肾和 HF 相关的死亡率。使用国际疾病分类，第 10 次修订版代码 (I13.x) 对 15 岁或以上死者的心肾相关死亡 (I13.x) 和 HF 相关死亡 (I11.0、I13.0、I13.2 和 I50.x) 进行分类。死者进一步按年龄组、性别、种族或民族分层。计算每 100,000 人死亡的粗死亡率和年龄调整死亡率 (AAMR)。共发生 97,135 例与心肾相关的死亡和 3,453,655 例与 HF 相关的死亡。与 HF 相关的死亡率 (AAMR，115.7；95%CI：115.6-115.8) 明显高于与心肾相关的死亡率 (AAMR，3.26；95%CI：3.23-3.28)。与心肾相关的死亡率的年变化百分比 (APC) 更高，且随着时间的推移而增加 (2011-2015：APC，7.1%；95%CI：0.7-13.9%；2015-2020：APC，19.7%，95%CI：16.3-23.2%)，而 HF 相关的死亡率在此期间也有所增加，但速度一直较慢 (2011-2020：APC，2.4%；95%CI：1.7-3.1%)。两个原因导致死亡率在年龄较大和男性死者中最高。与 HF 相关的死亡率在非西班牙裔或拉丁裔黑人和白人中都很高，但与心肾相关的死亡率相似。与 HF 相关的死亡率相比，心肾相关的死亡率中列出心肾综合征作为根本死因的比例更大 (67.0% vs. 1.2%)。
HF 相关的死亡人数大大超过了与心肾相关的死亡人数；然而，与心肾相关的死亡人数以惊人的速度增加，非西班牙裔或拉丁裔黑人的负担最重。持续监测与心肾相关的死亡率趋势至关重要，未来需要进行包含心肾综合征相关生物标志物和社会决定因素详细信息的研究，以确定死亡率趋势差异的潜在机制。
