AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
A Paradoxical SDI Gradient in High Fasting Plasma Glucose-Attributable Chronic Kidney Disease Mortality: A GBD 2023 Seven-Region Joinpoint Analysis, 1990-2023
By Sajjad M, Sajjad A, Amer R et al.
Background: Chronic kidney disease (CKD) mortality attributable to high fasting plasma glucose (HFPG) is rising globally, yet formally validated multi-regional trend comparisons using GBD 2023 data are lacking. Methods: Age-standardized CKD mortality rates attributable to HFPG were extracted from the GBD 2023 Results Tool (IHME) for seven GBD regions spanning the Socio-demographic Index (SDI) spectrum: East Asia, South Asia, Southeast Asia, Central Europe, High-income Asia Pacific, Western Europe, and High-income North America, 1990-2023. Joinpoint regression (NCI v6.0.1; Weighted BIC; 5,001 resamples) identified inflection points and computed APC and AAPC with 95% CIs. Results: A striking SDI-patterned gradient emerged. Low-middle SDI regions recorded the smallest increases: East Asia (2.94 to 4.06 per 100,000; AAPC +1.04%; p<0.001) and South Asia (2.00 to 2.96; AAPC +1.20%; p<0.001). Middle SDI regions showed intermediate rises: Southeast Asia (3.06 to 6.91; AAPC +2.49%; p<0.001) and Central Europe (3.35 to 7.59; AAPC +2.58%; p<0.001). High-income regions recorded the most dramatic surges: High-income Asia Pacific (6.25 to 16.80; AAPC +2.99%; p<0.001), Western Europe (4.23 to 12.53; AAPC +3.37%; p<0.001), and High-income North America (2.92 to 18.75; AAPC +6.08%; 95% CI 5.90-6.26; p<0.001). North America rose from the second lowest to the highest rate across all seven regions (+543%), with all four Joinpoint segments statistically significant. Conclusions: HFPG-attributable CKD mortality follows a paradoxical SDI gradient: high-income regions bear the greatest and fastest-growing burden while lower-SDI regions remain comparatively stable. North America’s +543% increase over 34 years highlights a substantial and previously underappreciated cardiometabolic-renal burden.