Cardiometabolic comorbidity burden and mortality in the United States and China

Hypertension, diabetes mellitus, and dyslipidemia are clustered metabolic disorders. Using harmonized data from four cohorts in the United States and China (38,984 participants), we defined cardiometabolic comorbidity burden (CMB) as the count of these disorders. Cohort-specific Cox models and random-effects meta-analysis showed graded associations with all-cause mortality. Compared with CMB count 0, pooled hazard ratios (HRs) were 1.10 (95% confidence interval [CI]: 0.95–1.28), 1.43 (95% CI: 1.09–1.87), and 2.45 (95% CI: 1.56–3.83) for counts 1, 2, and 3. In United States cohorts, counts 2 and 3 were associated with cardiovascular mortality. In pooled analyses, hypertension and diabetes mellitus were associated with higher all-cause mortality, whereas dyslipidemia was not significantly associated. Coexisting hypertension and diabetes mellitus had the strongest association among two-disorder combinations. CMB showed modest predictive improvement, with population-attributable fractions concentrated among counts 2 and 3.