Global transitions of concomitant patterns and risk factors of cardio-renal-metabolic conditions among the elderly.

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.