Temporal trends and disparities in mortality among US adults with chronic kidney disease and comorbid depression: a population-based analysis, 1999-2023.

BACKGROUND

Chronic kidney disease (CKD) and depression frequently co-occur, yet population-level mortality trends for their joint occurrence are poorly characterized.

METHODS

Using the CDC WONDER multiple-cause-of-death database, we examined annual age-adjusted mortality rates (AAMR) per 100,000 population among U.S. adults aged ≥ 25 years with CKD and co-occurring depression from 1999 to 2023. Joinpoint regression was employed to estimate annual percent change (APC) and average annual percent change (AAPC). Trends were stratified by sex, age, race, census region, and urban-rural residence. A Poisson log-linear model tested trend heterogeneity between CKD overall and CKD with depression during 2016-2021.

RESULTS

11,076 deaths were attributed to CKD with co-occurring depression. Overall AAMR increased from 0.12 to 0.22 per 100,000 (AAPC, 2.32%; 95% CI, -3.48 to 8.47%). Joinpoint analysis identified a critical inflection point in 2015, after which mortality surged at an APC of 9.89% (95% CI, 6.39 to 13.50%; p < 0.001). In contrast, CKD overall mortality decelerated after 2016 and plateaued recently. The post-2015 slope for CKD with depression significantly exceeded that of CKD overall (p for interaction < 0.0001). Acceleration was most pronounced among men, adults aged ≥85 years, residents of the South, and nonmetropolitan populations. Sensitivity analysis restricted to 2013-2023 yielded a sustained upward APC of 7.38% (95% CI, 5.00-10.41%; p < 0.0001).

CONCLUSION

Mortality among CKD with co-occurring depression has accelerated sharply since 2015, diverging markedly from the plateauing trend of CKD overall. Routine depression screening integration into nephrology care is urgently warranted, especially for high-risk populations.