Decline and Resurgence of Cardiovascular–Kidney–Metabolic Syndrome–Related Deaths Involving Malnutrition in the United States, 1999 to 2023

BACKGROUND: Cardiovascular-kidney-metabolic syndrome (CKM) contributes substantially to death, but the extent of malnutrition documentation among CKM-attributed deaths is unclear. We quantified temporal trends and disparities in US CKM-related deaths involving malnutrition from 1999 to 2023. METHODS: Using Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research Multiple Cause of Death data, we identified deaths with CKM as the underlying cause and malnutrition as a contributing cause. We calculated age-adjusted mortality rates (AAMRs) per 100 000 using the 2000 US standard population, assessed trends with joinpoint regression, quantified malnutrition involvement using an AAMR-based share, and modeled the death-count-based share with weighted binomial regression. RESULTS: National AAMRs followed a U-shaped pattern, declining from 2.31 in 1999 to about 0.9 in the early 2010s, then increasing to 3.78 (95% CI, 3.71-3.85) in 2023 (average annual percentage change, 2.1%). Despite declining overall CKM death, the AAMR-based share increased from 0.67% to 1.40%. Adults aged ≥65 years accounted for most deaths and had higher AAMRs than younger adults, although younger decedents showed faster adjusted annual increases in malnutrition documentation. Black adults had the highest AAMRs throughout, whereas relative increases in malnutrition involvement were steeper among White adults. The West had higher baseline odds and the most rapid acceleration. CONCLUSIONS: Malnutrition involvement in CKM-attributed deaths increased over time despite declining overall CKM deaths, highlighting malnutrition as an underrecognized component of end-of-life vulnerability in CKM and supporting integration of nutritional assessment and supportive care in high-burden populations and regions.