Abstract WE424: Cardiovascular-Kidney-Metabolic Syndrome Across a Decade: Trajectories in Relation to Social Determinants of Health among Middle-Aged and Older Adults in the United States

Background: Cardiovascular-Kidney-Metabolic (CKM) syndrome, a cluster of conditions, including cardiovascular disease, chronic kidney disease, and type 2 diabetes, is classified by the American Heart Association (AHA) into five stages of severity (0-4). Since 2023, CKM has been widely recognized as a major health concern in the United States (U.S.); however, evidence of social determinants of health (SDOH) influencing its trajectory under current medical care remains limited. Objective: This study investigated 5- and 10-year patterns of CKM trajectories and their association with SDOH among U.S. adults. Methods: Data were pooled from two U.S. cohort studies: the Multi-Ethnic Study of Atherosclerosis and the Coronary Artery Risk Development in Young Adults. CKM stages were defined according to AHA criteria, and their trajectories were classified as regressed, stable, and progressed, based on 5-year (2000-2005) and 10-year (2000-2010) stage changes, which were assessed as a binary outcome (progressed vs. regressed/stable). SDOH were evaluated across four major domains: economic stability, education, community and social context, and health care. Multivariable logistic regression was applied to examine associations between SDOH and CKM trajectories. Results: A total of 6543 adults with CKM were included (mean age 53.3 years (SEM 0.16); 54.1% female; 46.3% White), and most had stable CKM status (Y5: 67.1%; Y10: 55.6%). Over a 5-year follow-up, being unmarried was associated with higher odds of progression after adjusting for demographic and lifestyle factors (OR 1.15, 95% CI 1.01-1.31). Over 10 years of follow-up, being unemployed (OR 1.38, 95% CI 1.03-1.84) and unmarried (OR 1.14, 95% CI 1.00-1.29) were associated with higher odds of progression. Individuals with ≥ 3 adverse SDOH factors were more likely to experience progression over 5- (OR 1.11, 95% CI 1.02-1.20) and 10-year follow-up (OR 1.09, 95% CI 1.01-1.17) consistently. Conclusion: This study demonstrates that individuals with adverse SDOH profiles are more likely to experience CKM progression over 5- and 10-year follow-up. These findings highlight the need for tailored strategies for CKM syndrome management that specifically address the impact of unfavorable SDOH.