Cardiovascular and All-Cause Mortality in Behavioral Clusters of Adults With Cardiometabolic Syndrome: A Data-Driven Model

Background: Cardiometabolic syndrome is a major global driver of poor outcomes. Behavioral and socioeconomic factors influence outcomes of cardiometabolic syndrome. Conventional risk models often neglect to capture the role of behavioral and socioeconomic characteristics in cardiometabolic syndrome mortality. Objective: We aimed to identify behavioral–socioeconomic phenotypes among adults with cardiometabolic syndrome using a clustering approach and to examine their associations with cardiovascular and all-cause mortality. Methods: We analyzed data from 7839 U.S. adults with cardiometabolic syndrome (2005–2018), followed for a median of 87 months. To explore behavioral–socioeconomic patterns, we used hierarchical clustering on factor analysis of mixed data. Survival analyses were performed using Kaplan–Meier curves with log-rank tests to evaluate mortality differences among clusters. Cluster profile differences were assessed to characterize the demographic, behavioral, socioeconomic, and clinical heterogeneity among the identified subgroups. Results: Three distinct clusters were identified, differing significantly across demographic, socioeconomic, and behavioral characteristics ( P < .001 for most comparisons). Cluster 1 comprised younger, socioeconomically deprived, physically active individuals with higher alcohol use and depression prevalence. Cluster 2 included predominantly older women with lower socioeconomic status, multiple comorbidities, and the poorest cardiometabolic profile, showing the highest cardiovascular and all-cause mortality rates (all log-rank P < .001). Cluster 3 represented socioeconomically advantaged, middle-aged men with the most favorable behavioral patterns and the lowest depression prevalence. Conclusion: Behavioral–socioeconomic clustering identified phenotypes with distinct prognoses in cardiometabolic syndrome. The high-risk cluster 2 reflects the cumulative physiological consequences of long-standing adverse behaviors, socioeconomic deprivation, and comorbid disease progression.