Junwen Wang

Background: Cardiovascular–kidney–metabolic syndrome (CKM) contributes substantially to death, but the extent of malnutrition documentation among CKM–attributed deaths is unclear. We quantified temporal trends and disparities in US CKM‐related deaths involving malnutrition from 1999 to 2023. Methods: Using Centers for Disease Control and Prevention Wide‐Ranging Online Data for Epidemiologic Research Multiple Cause of Death data, we identified deaths with CKM as the underlying cause and malnutrition as a contributing cause. We calculated age‐adjusted mortality rates (AAMRs) per 100 000 using the 2000 US standard population, assessed trends with joinpoint regression, quantified malnutrition involvement using an AAMR‐based share, and modeled the death‐count–based share with weighted binomial regression. Results: National AAMRs followed a U‐shaped pattern, declining from 2.31 in 1999 to about 0.9 in the early 2010s, then increasing to 3.78 (95% CI, 3.71–3.85) in 2023 (average annual percentage change, 2.1%). Despite declining overall CKM death, the AAMR‐based share increased from 0.67% to 1.40%. Adults aged ≥65 years accounted for most deaths and had higher AAMRs than younger adults, although younger decedents showed faster adjusted annual increases in malnutrition documentation. Black adults had the highest AAMRs throughout, whereas relative increases in malnutrition involvement were steeper among White adults. The West had higher baseline odds and the most rapid acceleration. Conclusions: Malnutrition involvement in CKM‐attributed deaths increased over time despite declining overall CKM deaths, highlighting malnutrition as an underrecognized component of end‐of‐life vulnerability in CKM and supporting integration of nutritional assessment and supportive care in high‐burden populations and regions.

Introduction: In 2013, the United States (U.S.) Preventive Services Task Force recommended low-dose computed tomography (LDCT) for lung-cancer screening. We assessed temporal, population-level changes in incidence, stage at diagnosis, and mortality before and after this recommendation among adults aged 55–79 years. Methods: Using the US Centers for Disease Control and Prevention Wide-ranging Online Data WONDER (CDC WONDER), Global Burden of Disease (GBD), and SEER data, we examined age-adjusted incidence (AAIR) and mortality (AAMR) trends. Joinpoint regression and interrupted time-series (ITS) models evaluated pre- and post-2014 changes in population-level trends; counterfactual analyses estimated differences between observed outcomes and projections based on pre-2014 trends. SEER was used to characterize stage distributions (localized, regional, distant). Results: Post-2014 declines accelerated across data systems. Annual AAMR decreased by 3.03% in CDC WONDER and 2.58% in GBD; AAIR declined by 1.85% and 2.37%, respectively. SEER showed a higher proportion of localized disease and fewer distant-stage diagnoses after 2014; joinpoint analyses identified a 2013 inflection with steeper declines in distant-stage incidence thereafter. In models extrapolating pre-2014 trends to subsequent years, observed deaths were lower than counterfactual projections by 28,168 in CDC WONDER and 6,906 in GBD. As an exploratory indicator, mortality-to-incidence ratios declined nationally and in both sexes. Conclusions: During the USPSTF LDCT guideline era, independent national datasets showed accelerated mortality declines and a shift toward localized-stage diagnoses. These convergent findings are temporally consistent with real-world benefits of LDCT screening, but they should be interpreted within a broader context that includes continued reductions in smoking, gradual screening uptake, and major therapeutic advances. The findings are hypothesis-generating and do not estimate the isolated causal effect of LDCT screening.