Prevalence of Cardiovascular-Kidney-Metabolic Stages in US Adolescents and Relationship to Social Determinants of Health

Importance: Given that many risk factors for atherosclerotic cardiovascular disease (ASCVD) begin in childhood, knowledge of the prevalence of cardio-kidney metabolic syndrome (CKM) in adolescents and its risk factors is critical to understanding the etiology of ASCVD risk burden.

Objective: To calculate the proportion of US adolescents with CKM stages 0, 1, and 2 and to assess the social factors and behaviors most strongly associated with advanced CKM stage.

Design: Cross-sectional analysis of 2017-2020 US National Health and Nutrition Examination Survey (NHANES) sample data.

Setting: United States.

Participants: Adolescents.

Exposure: Social determinants of health, including family income to poverty ratio, health insurance, routine healthcare access, and food security, as well as behaviors including smoking, physical activity, and diet.

Main outcomes and measures: The prevalence of CKM stages 0, 1, and 2 in adolescents was measured using survey-weighted data. Generalized linear models were used to quantify associations between social factors, behaviors, and CKM staging.

Results: Of the 1,774 surveyed adolescents ages 12-18 years, representing 30,327,145 US adolescents, 56% (95% CI 52-60%) had CKM stage 0, 37% (33-40%) had CKM stage 1, and 7% (5-9%) had CKM stage 2. Physical activity score (1 to 100, 100=highest) was lowest among adolescents with CKM stage 2 (physical activity score for CKM 0: 60 (31), CKM 1: 60 (32), and CKM 2 49 (33); p=0.025). Other health behaviors, such as the DASH diet and nicotine scores, did not differ according to the CKM stage (p=0.477 and p=0.932, respectively). According to sex, race, ethnicity, and age-adjusted multivariate logistic regression analyses, a ratio of income to poverty level >1.85, having health insurance, and food security, were associated with a 32% (OR 0.68 [95% CI:0.52,0.89]), 40% (OR 0.60 [95% CI: 0.37, 0.99]), and 45% (OR 0.55 [95% CI: 0.41,0.73]) lower odds of CKM stage 1-2, respectively. After adjustment for all sociodemographic factors, only food security was associated with 41% lower odds of CKM stage 1-2 (OR 0.59 [0.43, 0.81]).

Conclusions and relevance: CKM stage 1-2 in adolescents is most strongly associated with food insecurity. Improved access to healthy food and policies to address food security may help prevent higher CKM stage, beginning in adolescence.