Association of cardiovascular-kidney-metabolic syndrome with cardiovascular, cancer, and all-cause mortality among US adults: A prospective study

Cardiovascular-kidney-metabolic (CKM) syndrome, comprising chronic kidney disease, cardiovascular disease (CVD), and metabolic syndrome, poses a significant threat to global public health. This study aimed to explore its influence on CVD, cancer, and all-cause mortality among US adults. A total of 17,642 participants from the National Health and Nutrition Examination Survey 1999–2018 dataset were included and classified into different CKM stages. Weighted Cox regression and Kaplan–Meier survival analyses were conducted to evaluate the relationships between CKM stages and cancer, CVD, and all-cause mortality. Additionally, Fine-Gray competitive risk models were used to further assess cause-specific mortality outcomes. Participants with advanced CKM stages demonstrated significantly higher risks of cancer, CVD, and all-cause mortality. Compared to individuals in CKM stage 0, those in CKM stage 4 demonstrated significantly higher risks of all-cause mortality (hazard ratio [HR]: 2.89, 95% confidence interval [CI]: 1.99–4.20), CVD mortality (HR: 9.73, 95% CI: 3.06–30.92), and cancer mortality (HR: 2.41, 95% CI: 1.13–5.15). Kaplan–Meier survival curves and competitive risk models confirmed a progressive increase in mortality risk with advancing CKM stages. Stages of CKM syndrome are positively associated with cancer, CVD, and all-cause mortality risk, highlighting the significance of early detection and effective management.