{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T02:33:54Z","timestamp":1791513234353,"version":"4.3.4"},"reference-count":36,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Social risk factors contribute to cardiovascular, kidney, and metabolic disease; however, their associations with advanced cardiovascular-kidney-metabolic (CKM) syndrome and variation across demographic subgroups remain unclear.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To examine the association between individual social risk factors and advanced CKM syndrome and to assess whether these associations vary by age group, sex, and race and ethnicity.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This is a cross-sectional study of adults aged 30 years or older from the National Health and Nutrition Examination Survey 2005 to 2018 cycles. Data analysis was conducted from July to October 2025. Analyses incorporated survey weights to generate nationally representative estimates.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n Five social risk domains: economic instability, poor neighborhood environment, limited education, limited health care access, and poor social and\/or community context.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome was advanced CKM syndrome (stages 3-4) defined using American Heart Association criteria. Following tests for interactions by age, race and ethnicity, and sex, weighted logistic regression tested associations between social risks and advanced CKM syndrome, stratified by race and ethnicity and sex.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Among 28\u202f184 participants (representing 165.6 million US adults; mean [SD] age, 52.6 [14.2] years; 14\u202f378 female participants [51.9%]), 5879 (20.9% [weighted 15.8%]) had advanced CKM syndrome. Limited health care access was associated with lower odds of advanced CKM syndrome among non-Hispanic Black adults (odds ratio [OR], 0.69; 95% CI, 0.50-0.96), but there were no other significant associations with this social risk factor. No significant age interactions were found for limited education or limited health care access. Economic instability was associated with higher odds of advanced CKM syndrome among non-Hispanic Black adults (OR, 1.43; 95% CI, 1.13-1.81) and non-Hispanic White adults (OR, 1.55; 95% CI, 1.33-1.81). Poor neighborhood environment was significant for all racial and ethnic groups (OR range, 1.36-2.55). Limited education was associated with advanced CKM syndrome among non-Hispanic White adults (OR,\u20091.46; 95% CI, 1.23-1.72). Poor social and\/or community context was associated with advanced CKM across all groups except other racial and ethnic groups (ie, Asian, multiracial, or any other race and ethnicity not otherwise specified), with the highest OR among Hispanic adults (OR, 2.08; 95% CI, 1.62-2.68). Associations between social risks and advanced CKM syndrome were generally higher in women than men except for a higher odds of CKM syndrome with poor neighborhood environment among men.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this cross-sectional study of US adults, multiple social risk factors were associated with advanced CKM syndrome, with meaningful variation by race and ethnicity and sex. Integrating social risk screening into CKM syndrome prevention and tailoring interventions to high-risk subgroups may help reduce disparities and slow CKM syndrome progression.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.10702","type":"journal-article","created":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T15:00:17Z","timestamp":1777993217000},"page":"e2610702","source":"Crossref","is-referenced-by-count":2,"title":["Social Risk Factors and Disparities in Advanced Cardiovascular-Kidney-Metabolic Syndrome"],"prefix":"10.1001","volume":"9","author":[{"given":"Obinna","family":"Ekwunife","sequence":"first","affiliation":[{"name":"Division of Population Health, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuemeng","family":"Wang","sequence":"additional","affiliation":[{"name":"Division of Population Health, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raphael A.","family":"Fraser","sequence":"additional","affiliation":[{"name":"Division of Population Health, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Yunke","sequence":"additional","affiliation":[{"name":"Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer A.","family":"Campbell","sequence":"additional","affiliation":[{"name":"Division of Population Health, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebekah J.","family":"Walker","sequence":"additional","affiliation":[{"name":"Division of Population Health, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonard E.","family":"Egede","sequence":"additional","affiliation":[{"name":"Division of Population Health, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2026,5,5]]},"reference":[{"issue":"9669","key":"zoi260324r2","doi-asserted-by":"publisher","first-page":"1083","DOI":"10.1016\/S0140-6736(09)60318-4","article-title":"Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies.","volume":"373","author":"Whitlock","year":"2009","journal-title":"Lancet"},{"issue":"8","key":"zoi260324r3","doi-asserted-by":"publisher","first-page":"3182","DOI":"10.1093\/ndt\/gfs052","article-title":"Chronic kidney disease and life expectancy.","volume":"27","author":"Turin","year":"2012","journal-title":"Nephrol Dial Transplant"},{"issue":"1","key":"zoi260324r4","doi-asserted-by":"publisher","first-page":"3183","DOI":"10.1038\/s41598-020-60142-y","article-title":"Diabetes and all-cause mortality, a 18-year follow-up study.","volume":"10","author":"Salehidoost","year":"2020","journal-title":"Sci Rep"},{"issue":"1","key":"zoi260324r5","doi-asserted-by":"publisher","first-page":"2775","DOI":"10.1038\/s41598-024-53229-3","article-title":"Joint effect of BMI and metabolic status on mortality among adults: a population-based longitudinal study in United States.","volume":"14","author":"Chen","year":"2024","journal-title":"Sci Rep"},{"issue":"11","key":"zoi260324r6","doi-asserted-by":"publisher","first-page":"1050","DOI":"10.1001\/jamacardio.2023.3241","article-title":"Prevalence and overlap of cardiac, renal, and metabolic conditions in US adults, 1999-2020.","volume":"8","author":"Ostrominski","year":"2023","journal-title":"JAMA Cardiol"},{"issue":"6","key":"zoi260324r7","doi-asserted-by":"publisher","first-page":"970","DOI":"10.1016\/j.amjmed.2025.01.031","article-title":"Prevalence, disparities, and mortality of cardiovascular-kidney-metabolic syndrome in US adults, 2011-2018.","volume":"138","author":"Kim","year":"2025","journal-title":"Am J Med"},{"issue":"18","key":"zoi260324r8","doi-asserted-by":"publisher","first-page":"1829","DOI":"10.1001\/jama.2021.5469","article-title":"The leading causes of death in the US for 2020.","volume":"325","author":"Ahmad","year":"2021","journal-title":"JAMA"},{"issue":"16","key":"zoi260324r9","doi-asserted-by":"publisher","first-page":"e840","DOI":"10.1161\/CIR.0000000000000664","article-title":"Cardiorenal syndrome: classification, pathophysiology, diagnosis, and treatment strategies: a scientific statement from the American Heart Association.","volume":"139","author":"Rangaswami","year":"2019","journal-title":"Circulation"},{"issue":"7","key":"zoi260324r10","doi-asserted-by":"publisher","first-page":"951","DOI":"10.1161\/CIRCRESAHA.121.318093","article-title":"Obesity, adipose tissue and vascular dysfunction.","volume":"128","author":"Koenen","year":"2021","journal-title":"Circ Res"},{"issue":"20","key":"zoi260324r11","doi-asserted-by":"publisher","first-page":"1606","DOI":"10.1161\/CIR.0000000000001184","article-title":"Cardiovascular-kidney-metabolic health: a presidential advisory from the American Heart Association.","volume":"148","author":"Ndumele","year":"2023","journal-title":"Circulation"},{"issue":"21","key":"zoi260324r12","doi-asserted-by":"publisher","first-page":"1858","DOI":"10.1001\/jama.2024.6892","article-title":"Prevalence of cardiovascular-kidney-metabolic syndrome stages in US adults, 2011-2020.","volume":"331","author":"Aggarwal","year":"2024","journal-title":"JAMA"},{"issue":"11","key":"zoi260324r13","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.45309","article-title":"Prevalence of cardiovascular-kidney-metabolic syndrome stages by social determinants of health.","volume":"7","author":"Zhu","year":"2024","journal-title":"JAMA Netw Open"},{"issue":"2","key":"zoi260324r14","doi-asserted-by":"publisher","first-page":"407","DOI":"10.1111\/1468-0009.12390","article-title":"Meanings and misunderstandings: a social determinants of health lexicon for health care systems.","volume":"97","author":"Alderwick","year":"2019","journal-title":"Milbank Q"},{"issue":"9","key":"zoi260324r15","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1007\/s11883-021-00949-w","article-title":"Social determinants of health and cardiovascular disease: current state and future directions towards healthcare equity.","volume":"23","author":"Jilani","year":"2021","journal-title":"Curr Atheroscler Rep"},{"issue":"1","key":"zoi260324r16","doi-asserted-by":"publisher","DOI":"10.1136\/bmjdrc-2023-003710","article-title":"Unfavorable social determinants of health and risk of mortality in adults with diabetes: findings from the National Health Interview Survey.","volume":"12","author":"Chang","year":"2024","journal-title":"BMJ Open Diabetes Res Care"},{"issue":"1","key":"zoi260324r17","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1186\/s12882-021-02277-2","article-title":"The cumulative impact of social determinants of health factors on mortality in adults with diabetes and chronic kidney disease.","volume":"22","author":"Ozieh","year":"2021","journal-title":"BMC Nephrol"},{"issue":"9","key":"zoi260324r18","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.30853","article-title":"Association of social risk domains with poor cardiovascular risk factor control in US adults with diabetes, from 2006 to 2016.","volume":"5","author":"Corwin","year":"2022","journal-title":"JAMA Netw Open"},{"issue":"4","key":"zoi260324r19","doi-asserted-by":"publisher","DOI":"10.1016\/j.jnha.2025.100504","article-title":"Associations of cardiovascular-kidney-metabolic syndrome stages with premature mortality and the role of social determinants of health.","volume":"29","author":"Zhu","year":"2025","journal-title":"J Nutr Health Aging"},{"issue":"16","key":"zoi260324r20","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.124.034996","article-title":"Social risk profile and cardiovascular-kidney-metabolic syndrome in US adults.","volume":"13","author":"Li","year":"2024","journal-title":"J Am Heart Assoc"},{"issue":"1","key":"zoi260324r21","doi-asserted-by":"publisher","first-page":"369","DOI":"10.1186\/s12872-025-04812-7","article-title":"Social determinants of health (SDOH) associated with the risk of all-cause mortality and life expectancy in US adults with cardiovascular-kidney-metabolic syndrome: a NHANES 2001-2018 cohort study.","volume":"25","author":"Yang","year":"2025","journal-title":"BMC Cardiovasc Disord"},{"issue":"9596","key":"zoi260324r24","doi-asserted-by":"publisher","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.","volume":"370","author":"von Elm","year":"2007","journal-title":"Lancet"},{"issue":"19","key":"zoi260324r26","doi-asserted-by":"publisher","first-page":"1737","DOI":"10.1056\/NEJMoa2102953","article-title":"New creatinine- and cystatin c-based equations to estimate GFR without race.","volume":"385","author":"Inker","year":"2021","journal-title":"N Engl J Med"},{"key":"zoi260324r27","doi-asserted-by":"publisher","first-page":"S117","DOI":"10.1016\/j.kint.2023.10.018","article-title":"KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease.","volume":"105","author":"Kidney disease: improving global outcomes (KDIGO) CKD work group","year":"2024","journal-title":"Kidney Int"},{"issue":"4S","key":"zoi260324r28","doi-asserted-by":"publisher","first-page":"S117","DOI":"10.1016\/j.kint.2023.10.018","article-title":"KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease.","volume":"105","author":"Stevens","year":"2024","journal-title":"Kidney Int"},{"issue":"24","key":"zoi260324r29","doi-asserted-by":"publisher","first-page":"1982","DOI":"10.1161\/CIR.0000000000001191","article-title":"Novel prediction equations for absolute risk assessment of total cardiovascular disease incorporating cardiovascular-kidney-metabolic health: a scientific statement from the American Heart Association.","volume":"148","author":"Khan","year":"2023","journal-title":"Circulation"},{"issue":"6","key":"zoi260324r30","doi-asserted-by":"publisher","first-page":"430","DOI":"10.1161\/CIRCULATIONAHA.123.067626","article-title":"Development and validation of the American Heart Association\u2019s PREVENT equations.","volume":"149","author":"Khan","year":"2024","journal-title":"Circulation"},{"issue":"9","key":"zoi260324r32","doi-asserted-by":"publisher","first-page":"606","DOI":"10.1046\/j.1525-1497.2001.016009606.x","article-title":"The PHQ-9: validity of a brief depression severity measure.","volume":"16","author":"Kroenke","year":"2001","journal-title":"J Gen Intern Med"},{"issue":"1","key":"zoi260324r33","doi-asserted-by":"publisher","DOI":"10.1111\/nin.12268","article-title":"Marginalization: conceptualizing patient vulnerabilities in the framework of social determinants of health\u2014an integrative review.","volume":"26","author":"Baah","year":"2019","journal-title":"Nurs Inq"},{"issue":"1","key":"zoi260324r35","doi-asserted-by":"publisher","first-page":"2","DOI":"10.4103\/ijoem.IJOEM_53_16","article-title":"Healthy worker effect phenomenon: revisited with emphasis on statistical methods\u2014a review.","volume":"21","author":"Chowdhury","year":"2017","journal-title":"Indian J Occup Environ Med"},{"issue":"6","key":"zoi260324r36","doi-asserted-by":"publisher","first-page":"1564","DOI":"10.1007\/s10903-021-01313-5","article-title":"Understanding the healthy immigrant effect in the context of mental health challenges: a systematic critical review.","volume":"24","author":"Elshahat","year":"2022","journal-title":"J Immigr Minor Health"},{"key":"zoi260324r1","unstructured":"WatersH, GrafM. America\u2019s obesity crisis: the health and economic costs of excess weight. Milken Institute. 2018. Accessed September 3, 2025. https:\/\/milkeninstitute.org\/sites\/default\/files\/reports-pdf\/Mi-Americas-Obesity-Crisis-WEB.pdf"},{"key":"zoi260324r22","unstructured":"US Department of Health and Human Services. Healthy people 2030: social determinants of health. 2025. Accessed June 9, 2025. http:\/\/odphp.health.gov"},{"key":"zoi260324r23","unstructured":"US Centers for Disease Control and Prevention: National Center for Health Statistics. National Health and Nutrition Examination Survey. 2025. Accessed March 19, 2026. https:\/\/www.cdc.gov\/nchs\/nhanes\/index.html"},{"key":"zoi260324r25","unstructured":"US Centers for Disease Control and Prevention. National health and nutrition examination survey: weighting. 2025. Accessed March 19, 2026. https:\/\/wwwn.cdc.gov\/nchs\/nhanes\/tutorials\/Weighting.aspx"},{"key":"zoi260324r31","unstructured":"ArtigaS, HintonE. Beyond health care: the role of social determinants in promoting health and health equity. KFF. 2018. Accessed March 19, 2026. https:\/\/www.kff.org\/racial-equity-and-health-policy\/beyond-health-care-the-role-of-social-determinants-in-promoting-health-and-health-equity"},{"key":"zoi260324r34","unstructured":"Centers for Medicare & Medicaid Services. Young adults and the Affordable Care Act: protecting young adults and eliminating burdens on families and businesses. 2024. Accessed March 19, 2026. https:\/\/www.cms.gov\/cciio\/resources\/files\/adult_child_fact_sheet"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2848615\/ekwunife_2026_oi_260324_3672401_1790971199.12873.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T15:00:37Z","timestamp":1791471637000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2848615"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,5]]},"references-count":36,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,5,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2026.10702","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,5]]}}}