Burden, Drivers, and Age-related Heterogeneity of Key Components of Cardiovascular-kidney-metabolic Syndrome in China, 1990-2023: A National Burden Analysis with an Exploratory Patient-level Clinical Analysis
Rui Zhu, Zhen Wu, Yueru Jiao, Ying Ding, Yang Zhang, Qiangguo AoBackground:
The long-term burden, demographic drivers, and age-related heterogeneity of key cardiovascular-kidney-metabolic (CKM) syndrome components in China remain incompletely characterized. We aimed to quantify national trends in seven selected CKM syndrome components in China from 1990 to 2023, identify demographic and epidemiological drivers of burden change, and explore age-related heterogeneity using complementary clinical data.
Methods:
Using estimates from the Global Burden of Disease (GBD) 2023 study, we analyzed seven selected CKM syndrome components: high body mass index (BMI), diabetes, chronic kidney disease (CKD), atrial fibrillation and flutter, lower extremity peripheral arterial disease, ischemic heart disease, and stroke. Incidence, prevalence, mortality, disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs) were assessed by year, age, and sex. The Das Gupta decomposition method was used to quantify the contributions of population aging, population growth, and epidemiological change, while joinpoint regression was used to estimate annual percentage changes (APCs) and average APCs. In an exploratory analysis of 2938 geriatric clinical records, age-related associations were assessed using nested multivariable logistic regression models. Predictive patterns were further explored using a 7:3 stratified train-test split; least absolute shrinkage and selection operator (LASSO)-based feature selection, followed by extreme gradient boosting modeling; generalized additive models; and Shapley Additive Explanations (SHAP) analysis.
Results:
In 2023, CKD had the highest prevalence among the selected components, with 156.15 million cases, followed by diabetes, with 109.43 million cases. Stroke and ischemic heart disease accounted for the most DALYs, at 42.80 and 37.02 million person-years, respectively, whereas high BMI and diabetes were major contributors to YLDs. From 1990 to 2023, all-age DALYs increased for high BMI, diabetes, atrial fibrillation and flutter, lower extremity peripheral arterial disease, and ischemic heart disease, while changes were smaller for CKD and stroke. Age-standardized DALY rates declined or remained broadly stable for most components, indicating that population aging and growth were the dominant drivers of the increasing absolute burden. In the exploratory clinical analysis, older age was positively associated with ischemic heart disease, stroke, lower extremity peripheral arterial disease, atrial fibrillation, and CKD but inversely associated with high BMI and diabetes. Model-assisted analyses further suggested heterogeneous, nonlinear age-related patterns across CKM components.
Conclusion:
The burden of key CKM syndrome components in China has increased substantially over three decades, mainly driven by demographic aging and persistent metabolic risk. Integrated prevention should combine population-level monitoring with age- and disease-specific risk stratification.