Zhu Ruixin, Wang Ran, He Jingjing, Wang Langrun, Chen Huiyu, Wang Yifan, An Peng, Li Keji, Ren Fazheng, Xu Weili, Martinez J Alfredo, Raben Anne, Guo Jie
Key Laboratory of Precision Nutrition and Food Quality, Department of Nutrition and Health, China Agricultural University, Beijing, China.
Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing, China.
J Nutr Health Aging. 2025 Apr;29(4):100504. doi: 10.1016/j.jnha.2025.100504. Epub 2025 Feb 13.
The American Heart Association defined cardiovascular-kidney-metabolic (CKM) syndrome as a novel multi-stage disorder. We examined the associations of CKM stages with premature mortality and the role of social determinants of health (SDOHs).
A prospective cohort study.
A nationally representative sample of US adults from NHANES 1999-2018.
CKM included 5 stages (stages 0-4), reflecting progressive pathophysiology. Premature mortality (deaths before 75 years) were ascertained via linkage to the National Death Index with follow-up until 2019. Cox proportional-hazards models adjusted for age, sex, race/ethnicity, medical history, and other confounding factors were used to calculate the hazard ratios (HR) and 95% CIs for CKM-mortality associations.
Among 27,909 participants (mean age 49.7 years, 49.0% females), 1762 premature deaths occurred over a median follow-up of 8.3 years. Compared with stage 0, the adjusted HRs for all-cause premature mortality at CKM stages 1-4 were 0.88 (95% CI 0.66-1.17), 1.31 (0.99-1.73), 1.94 (1.31-2.87), and 2.19 (1.61-2.98), respectively. For CVD premature mortality, the adjusted HRs for CKM stages 1-4 were 1.12 (0.46-2.72), 1.74 (0.71-4.28), 3.93 (1.53-10.12), and 6.48 (2.95-14.20), respectively. Among adults at CKM stages 3-4, unfavorable SDOHs, particularly not living with a partner, low family income, lack of private health insurance, unemployment, or ≥2 cumulative SDOHs (4.16, 95% CI 3.35-5.18) were associated with increased all-cause premature mortality. Among those at CKM stages 0-2, unfavorable SDOHs were also related to increased premature mortality.
CKM stages 3-4, but not stages 1-2, were associated with increased risks of premature mortality compared with stage 0. The risks were increased by unfavorable SDOHs across CKM stages.
美国心脏协会将心血管-肾脏-代谢（CKM）综合征定义为一种新型的多阶段疾病。我们研究了CKM各阶段与过早死亡的关联以及健康的社会决定因素（SDOHs）的作用。
一项前瞻性队列研究。
来自1999 - 2018年美国国家健康与营养检查调查（NHANES）的具有全国代表性的美国成年人样本。
CKM包括5个阶段（0 - 4期），反映了渐进性病理生理学。通过与国家死亡指数的关联确定过早死亡（75岁之前死亡），随访至2019年。使用针对年龄、性别、种族/民族、病史和其他混杂因素进行调整的Cox比例风险模型来计算CKM与死亡率关联的风险比（HR）和95%置信区间（CI）。
在27909名参与者（平均年龄49.7岁，49.0%为女性）中，在中位随访8.3年期间发生了1762例过早死亡。与0期相比，CKM 1 - 4期全因过早死亡的调整后HR分别为0.88（95%CI 0.66 - 1.17）、1.31（0.99 - 1.73）、1.94（1.31 - 2.87）和2.19（1.61 - 2.98）。对于心血管疾病过早死亡，CKM 1 - 4期的调整后HR分别为1.12（0.46 - 2.72）、1.74（0.71 - 4.28）、3.93（1.53 - 10.12）和6.48（2.95 - 14.20）。在CKM 3 - 4期的成年人中，不利的SDOHs，特别是未与伴侣同住、家庭收入低、缺乏私人健康保险、失业或累计≥2种SDOHs（4.16，95%CI 3.35 - 5.18）与全因过早死亡风险增加相关。在CKM 0 - 2期的人群中，不利的SDOHs也与过早死亡风险增加有关。
与0期相比，CKM 3 - 4期而非1 - 2期与过早死亡风险增加相关。在CKM各阶段，不利的SDOHs都会增加风险。
