{
  "abstract": "Background: Cardiovascular prevention is increasingly prioritised using burden estimates, yet disability-adjusted life years (DALYs) reward late-stage treatment by construction. Whether that bias is large for cardiovascular-kidney-metabolic (CKM) syndrome, and where the population is accumulating relative to where the burden sits, is unknown. Methods: We pooled nine National Health and Nutrition Examination Survey cycles (2005-2023) and assigned CKM stages 0-4 from measured blood pressure, adiposity, glycaemia, lipids, kidney function, urine albumin, self-reported cardiovascular disease, and 10-year PREVENT risk. Years lived with disability used GBD disability weights. Years of life lost combined national death counts, stage-specific mortality from linked mortality files (1999-2018), and period life tables. A second aim attributed burden to smoking and physical inactivity, two exposures outside the CKM definition. Results: In 2021-2023, 13.8% of adults were stage 0, 21.3% stage 1, 49.1% stage 2, 6.5% stage 3, and 9.3% stage 4. CKM accounted for 20.0 million DALYs annually (7,881 age-standardised per 100,000), of which 4.1 million were YLD and 15.9 million attributable YLL. Stages 3-4, 15.8% of adults, generated 76% of attributable YLL; stage 4 alone generated 65% of YLD and 49% of attributable YLL. Adjusted mortality rose from stage 2 (hazard ratio 1.39) through stage 4 (3.22), while stage 1 did not differ from stage 0 (0.99; 95% CI, 0.78-1.25). Between 2006 and 2016, stage 0 prevalence fell 2.3% per year and stage 1 rose 3.1% per year. Smoking and physical inactivity accounted for 30.5% of burden (95% CI, 25.7-35.1). Conclusions: CKM burden is concentrated in stages 3-4, where excess mortality begins, while the population has been shifting into stage 1, where mortality is normal. DALY-based prioritisation will therefore systematically underfund the stage in which the next generation of patients is being created.",
  "abstract_shown": true,
  "affiliations": [
    "Beijing University of Chinese Medicine Dongfang Hospital"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 6,
  "authors": [
    {
      "name": "X. Wang"
    },
    {
      "name": "Y. Qiao"
    },
    {
      "name": "H. Sun"
    },
    {
      "name": "Y. Wang"
    },
    {
      "affs": [
        0
      ],
      "name": "H. Zhou"
    },
    {
      "name": "T. Zhang"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/8ynr3m3tqd5mx.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.11.05.26367395",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.11.05.26367395v1.full",
  "id": "8ynr3m3tqd5mx",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.11.05.26367395v1",
  "language": null,
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "cardiovascular medicine"
    ]
  ],
  "openalex": null,
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.11.05.26367395v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-11-05",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/8ynr3m3tqd5mx.ris",
  "sources": [
    {
      "first_seen": "2026-11-07T12:20:29Z",
      "native_id": "10.64898/2026.11.05.26367395",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.11.05.26367395v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:cardiovascular medicine",
      "subfield": "cardiovascular"
    }
  ],
  "title": "Late-Stage Concentration of Cardiovascular-Kidney-Metabolic Syndrome Burden in US Adults: Disability-Adjusted Life Years Across AHA Stages, 2005 to 2023",
  "title_text": "Late-Stage Concentration of Cardiovascular-Kidney-Metabolic Syndrome Burden in US Adults: Disability-Adjusted Life Years Across AHA Stages, 2005 to 2023",
  "type": "preprint",
  "updated_at": "2026-11-08T00:21:01Z",
  "url": "https://research.draconitic.com/paper/8ynr3m3tqd5mx",
  "venue": "medRxiv",
  "versions": []
}