Spatiotemporal Trends in Chronic Kidney Disease Mortality and Its Association with Low Temperature in the United States (1999–2023)
TL;DR
CKD mortality in the United States increased from 1999 to 2023 with marked geographic and demographic disparities, and cold air temperature was associated with higher short-term mortality risk.
Abstract
Purpose Chronic kidney disease (CKD) is a major public health concern in the United States, with persistently rising incidence and mortality. This study aimed to quantify geographic and demographic disparities in CKD mortality across the United States and to examine the association between CKD mortality and ambient temperature variation. Patients and Methods CKD deaths and age-adjusted mortality rates (AAMRs) for 1999–2023 were obtained from CDC WONDER and stratified by census region, state, sex, race, age group, and urbanization level. Mortality trends were quantified using joinpoint regression. Primary temperature–mortality analyses used CDC WONDER-linked NLDAS temperature data for 1999–2011, while supplementary descriptive analyses used independently retrieved NLDAS temperature estimates for 2012–2023. Temperature–mortality associations were evaluated using Spearman rank correlations, quasi-Poisson regression models, and distributed lag nonlinear models (DLNMs). Results From 1999 to 2023, 628,937 CKD deaths occurred, with national AAMR increasing steadily. Mortality rates were consistently higher in men and nonmetropolitan areas. AAPC rose fastest in the West and Midwest, though recent AAMR declines were noted in the Northeast and South. Winter mortality exceeded summer across regions. In the primary DLNM analysis, cold exposure at the region-specific 5th percentile was associated with higher cumulative CKD mortality risk, with risk ration (RR) ranging from 1.065 in the Northeast to 1.505 in the Midwest; the association reached statistical significance only in the Midwest (RR 1.505, 95% CI: 1.091–2.075), while hot-exposure estimates at the 95th percentile were generally imprecise and not statistically significant. Conclusion CKD mortality in the United States increased from 1999 to 2023 with marked geographic and demographic disparities. Cold air temperature was associated with higher short-term mortality risk.