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BACKGROUND: Cardiovascular-kidney-metabolic (CKM) conditions increasingly contribute to cardiovascular disease (CVD) mortality, but temporal trends in social inequities and geographic priorities remain unclear. We quantified trends, disparities, and county-level priority areas for CKM-involved CVD mortality in the United States. METHODS: Using 2014-2023 US vital statistics, we estimated age-standardized CKM-involved CVD mortality. Negative binomial regression estimated Social Vulnerability Index (SVI) quintile-specific relative risks (RRs) and SVI×time interactions. Inequity was measured by the slope (SII) and relative (RII) index of inequality. Bayesian spatiotemporal smoothing identified 2022-2023 county-level RRs and worsening probability (Pincreasing). High-priority areas were defined by current risk (RR ≥ 1.43) and Pincreasing ≥ 0.80. RESULTS: National crude mortality rose from 36.37 per 100,000 (2014-2015) to 47.90 (2022-2023). Disparities significantly widened: the SVI Q5 vs. Q1 RR increased from 1.23 (95% CI, 1.18-1.28) to 1.34 (1.29-1.40) (interaction p=0.0197). Both absolute and relative gradients strengthened (SII: 10.48 to 21.12; RII: 1.30 to 1.45). County-level RRs (2022-2023) ranged from 0.24 to 4.87 with regional clustering. Overall, 356 counties (11.4%) were classified as high-risk and worsening. We identified 85 Tier 1 counties and estimated 1,721 national excess deaths. CONCLUSIONS: CKM-involved CVD mortality is increasing, and social inequities are widening. Geographically clustered counties face both high current risk and a high likelihood of worsening. These Tier 1 counties represent critical, actionable targets for place-based CKM prevention and treatment strategies.
Xia et al. (Mon,) studied this question.