Social Risk Factors and Disparities in Advanced Cardiovascular-Kidney-Metabolic Syndrome.

Importance: 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. Objective: 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. Design, Setting, and Participants: 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. Exposures: Five social risk domains: economic instability, poor neighborhood environment, limited education, limited health care access, and poor social and/or community context. Main Outcomes and Measures: 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. Results: Among 28 218 participants (representing 165.8 million US adults; mean [SD] age, 52.6 [14.2] years; 14 402 female participants [52.0%]), 12 614 (44.7%) had advanced CKM syndrome. No significant interactions were found for age. Economic instability was associated with higher odds of advanced CKM syndrome among non-Hispanic Black (odds ratio [OR], 1.27; 95% CI, 1.08-1.50) and non-Hispanic White adults (OR, 1.22; 95% CI, 1.08-1.37). Poor neighborhood environment was significant for non-Hispanic Black adults (OR, 1.20; 95% CI, 1.03-1.38). Limited education was associated with advanced CKM syndrome among non-Hispanic White adults (OR, 1.29; 95% CI, 1.13-1.48). Poor social and/or community context was associated across all groups, with the highest OR among Hispanic adults (OR, 1.72; 95% CI, 1.43-2.08). By sex, social risks were more associated with advanced CKM syndrome in women, with associations for men less prevalent and limited to economic instability, poor neighborhood environment, and poor social and/or community context. Conclusions and Relevance: In this cross-sectional study of US adults, multiple social risks 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.