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

Abstract

Background: Risk factors for atherosclerotic cardiovascular disease begin in youth. Knowledge of the prevalence of cardio‐kidney‐metabolic (CKM) syndrome in adolescents and its risk factors is critical to understanding the cause of atherosclerotic cardiovascular disease risk burden. Methods: We conducted a cross‐sectional analysis of the 2017 to 2020 US National Health and Nutrition Examination Survey data and determined the prevalence of each CKM stage in adolescents aged 12 to 18 years. We then assessed the relationship between the family income‐to‐poverty ratio, health insurance, routine health care access, food security, health behaviors, and CKM stage. We quantified associations between social factors, behaviors, and CKM stages using generalized linear and logistic models. Results: Of the 1774 surveyed US adolescents, representing 30 327 145, 56% (95% CI, 52–60) had CKM stage 0, 37% (95% CI, 33–40) had CKM stage 1, and 7% (95% CI, 5–9) had CKM stage 2. According to sex, race, ethnicity, and age‐adjusted analyses, a ratio of income‐to‐poverty level >1.85, having health insurance, and food security were associated with a 32% (odds ratio [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 to 2, respectively. After adjustment for all sociodemographic factors, only food security was associated with 40% lower odds of CKM stage 1 to 2 (OR, 0.60 [95% CI, 0.44–0.82]). Conclusions: In adolescents, CKM stages 1 to 2 are strongly associated with food insecurity. Improved access to healthy food and policies to address food security may help prevent higher CKM stages beginning in adolescence.