Clinical Scorecard: Trends in Mortality and Geographic Variations at the County Level for Advanced Stages 4 and 4b of Cardiovascular–Kidney–Metabolic Syndrome in the United States

At a Glance

Key Highlights

• Age-adjusted mortality rates for stage 4 declined from 505.54 to 353.30 per 100,000 from 1999 to 2023, with a detailed breakdown of annual changes.
• Stage 4b mortality rates decreased from 45.95 to 33.98 per 100,000 in the same period, with specific annual percent changes.
• Mortality trends reversed in the past decade, with increases in stage 4 and stage 4b after 2013 and 2015, respectively, supported by data.
• Geographic disparities noted, with high-burden areas in the Deep South and Appalachia for stage 4, including specific counties.
• Stage 4b hotspots showed more dispersed geographic clustering, with maps or data to illustrate.

Guideline-Based Recommendations

Diagnosis

• Operationally defined using ICD-10 codes for cardiovascular disease and kidney failure, with examples.

Management

• Target integrated cardio-renal risk reduction strategies based on geographic inequities, with specific examples.

Monitoring & Follow-up

• Surveillance of both absolute burden and kidney failure-associated mortality, with suggested metrics.

Risks

• Increased mortality rates observed in specific geographic regions, with data to support.

Patient & Prescribing Data

Individuals diagnosed with advanced CKM syndrome, particularly stages 4 and 4b, with demographic details.

Management considerations differ between stage 4a and stage 4b due to kidney failure, with specific treatment options.

Clinical Best Practices

• Utilize death certificate data for accurate mortality tracking, with methods for data collection.
• Implement targeted prevention strategies in high-burden geographic areas, with examples of successful interventions.
• Monitor trends in mortality to inform health-system planning, suggesting specific data points to track.

Related Resources & Content

• CDC WONDER Multiple Cause of Death database