Sex-specific Trends in Incidence, Prevalence, and Mortality of Chronic Kidney Disease (CKD) in the United States, 1990-2019: Findings from the Global Burden of Disease Study

Background: Chronic kidney disease (CKD) remains a major public health burden in the United States, affecting over 35 million adults. Despite improvements in the management of hypertension and diabetes, sex-based disparities in CKD burden persist, with women exhibiting higher prevalence but men facing worse outcomes. Objective: This study examined sex-specific trends in the incidence, prevalence, and mortality of CKD in the United States from 1990 to 2019 using data from the Global Burden of Disease (GBD) 2021 database. Methods: A retrospective analysis was conducted using age-standardized CKD incidence, prevalence, and mortality rates per 100,000 population, stratified by sex. Independent samples t-tests and Levene tests evaluated sex differences, while effect sizes (Cohen's d, Hedges' g, and Glass change) quantified their magnitude. Linear regression models assessed temporal trends over the 29-year period. Results: Females exhibited significantly higher mean incidence (326.10 vs. 290.34 per 100,000; P < 0.001) and prevalence (8,115.47 vs. 6,726.53 per 100,000; P < 0.001) than males, with large effect sizes across all measures from 1990 to 2019. Conversely, males demonstrated higher mean mortality (16.94 vs. 12.35 per 100,000; P < 0.001). Temporal analyses revealed modest increases in incidence for both sexes, a significantly faster rise in prevalence among females (β = 22.46, P < 0.001), and higher mortality growth among males (β = 0.57, P < 0.001). Conclusions: From 1990 to 2019, CKD incidence and prevalence increased more rapidly among women, whereas men consistently experienced higher mortality. These findings highlight persistent and widening sex disparities in CKD burden, likely reflecting both biological differences and gender-related inequities in healthcare access. Future prevention and treatment strategies should incorporate sex-specific approaches to reduce progression and mortality from CKD. Keywords: chronic kidney disease, sex differences, Global Burden of Disease, incidence, prevalence, mortality, United State