Temporal trends in cross-country inequalities of chronic kidney disease attributable to temperature exposure from 1990 to 2021.

BACKGROUND

Urbanization and climate change have increased temperature extremes contributing to chronic kidney disease (CKD) risks. Using 1990-2021 Global Burden of Disease (GBD) data, we analyzed trends and disparities in CKD burden attributable to non-optimal temperatures across regions, genders, and time.

METHODS

Data on CKD mortality and disability-adjusted life years (DALYs) were extracted from GBD 2021. Trends were evaluated using estimated annual percentage change (EAPC). Age-period-cohort (APC) modeling quantified age, period, and cohort effects. Age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) expressed burden per 100,000 population. Concentration indices assessed socioeconomic health inequalities, while demographic decomposition disentangled contributions of population aging, growth, and epidemiological changes.

RESULTS

Low-temperature-attributable CKD dominated globally in 2021 (ASMR: 0.99 [0.84-1.12]; ASDR: 20.27 [17.11-23.53]), exceeding high-temperature-attributable burden (ASMR: 0.21 [- 0.01 to 0.49]; ASDR: 5.74 [0.13-12.99]). Over three decades, high-temperature burden increased markedly, while low-temperature effects remained persistently elevated. Males and older adults showed disproportionate vulnerability. Low-SDI regions exhibited heightened sensitivity to heat, whereas high-SDI regions were more affected by cold. Decomposition revealed epidemiological changes as key drivers for heat-related burden versus population aging for cold-related burden. Health inequalities intensified for heat-related outcomes but declined for cold-related impacts.

CONCLUSIONS

Non-optimal temperatures impose differential CKD burdens globally, shaped by socioeconomic disparities and demographic shifts. Targeted interventions addressing gender-, age-, and SDI-stratified vulnerabilities, coupled with climate-resilient health policies, are urgently needed to mitigate temperature-driven kidney disease risks.