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Chronic Kidney Disease and Diabetes / Chronic Disease Management Strategies / Diabetes, Cardiovascular Risks, and Lipoproteins · Journal article
The Journals of Gerontology Series a · September 5, 2026
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This global epidemiological analysis reveals a fundamental regional transition in cardio-renal-metabolic disease patterns from 1990 to 2021, with high-income countries shifting from IHD dominance to T2DM and CKD predominance, while North Africa and the Middle East emerge as hotspots for concurrent high incidence. Modifiable risk factors—blood pressure and lipid control improvements associated with IHD/stroke decline; obesity and trans-fat intake linked to T2DM/CKD rises—show regional clustering that tracks incidence disparities, and addressing these factors is projected to yield meaningful gains in healthy life expectancy, particularly in regions with the highest burden.
Global population-level epidemiological analysis with Bayesian age-period-cohort modeling and machine learning. Adults aged ≥55 years across 204 countries and territories; includes all regions. Intervention: Analysis of population-level incidence patterns and risk factors; no intervention applied. Compared with: Regional and temporal comparisons across high-income, middle-income, and low-income regions; comparisons between 1990 baseline and 2021, with projections to 2035. 204 countries and territories globally.
Global IHD and stroke incidence declined from 1990 to 2021, while T2DM and CKD incidence rose over the same period High-income regions transitioned from IHD-dominated to T2DM- and CKD-predominant multimorbidity patterns North Africa and the Middle East became hotspots for concurrence of high cardio-renal-metabolic incidence
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Clinicians and public health professionals should recognize that cardio-renal-metabolic disease patterns are regionally heterogeneous and evolving; prevention strategies must be tailored to local risk factor profiles and regional transition stages to address widening global inequalities and optimize healthy longevity in older adults.
Rigorous global analysis across 204 countries using Bayesian age-period-cohort modeling and machine learning to identify multimorbidity patterns and risk factors for cardio-renal-metabolic disease in older adults, with clear regional trends and projections to 2035.
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Clinicians and public health professionals should recognize that cardio-renal-metabolic disease patterns are regionally heterogeneous and evolving; prevention strategies must be tailored to local risk factor profiles and regional transition stages to address widening global inequalities and optimize healthy longevity in older adults.
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BACKGROUND: Cardio-renal-metabolic (CRM) diseases-including ischemic heart disease (IHD), stroke, type 2 diabetes (T2DM), and chronic kidney disease (CKD)-pose major threats to healthy aging. Yet the co-occurrence and evolution of these conditions across regions, and their modifiable risk factors, remain unclear. METHODS: We analyzed CRM incidence among adults aged ≥55 years in 204 countries and territories from 1990 to 2021. Fifteen multimorbidity patterns were identified based on the population-level coexistence of high CRM incidence. Temporal dynamics were assessed using Bayesian age-period-cohort modeling, and interpretable machine learning was used to screen corresponding risk factors. RESULTS: From 1990 to 2021, global incidence declined for IHD and stroke but rose for T2DM and CKD. High-income regions transitioned from IHD-dominated to T2DM- and CKD-predominant patterns, while North Africa and the Middle East became hotspots for the concurrence of high CRM incidence. Inequalities linked to sociodemographic development widened and are projected to persist through 2035. Declines in IHD and stroke were associated with improvements in blood pressure and lipid control, whereas rises in obesity and trans-fat intake were linked to increases in T2DM and CKD. Regional variation and clustering of these risk factors corresponded to global disparities in incidence trends. Addressing these risk factors was projected to improve healthy life expectancy at age 55, particularly in the Middle East and North Africa. CONCLUSIONS: Co-occurrence of CRM conditions is undergoing a transition, characterized by heterogeneous regional risk profiles and widening inequalities. Targeted prevention and policy strategies may be considered to promote healthy longevity worldwide.
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