Compression or Expansion? Health Surveillance Trends in Cardiovascular and Diabetes Morbidity in the United States

Compression or Expansion? Health Surveillance Trends in Cardiovascular and Diabetes Morbidity in the United States | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Compression or Expansion? Health Surveillance Trends in Cardiovascular and Diabetes Morbidity in the United States Alberto Arletti, Lorenzo Schiavon, Mattia Stival, Michele Marzulli, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8367000/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 16 Apr, 2026 Read the published version in Scientific Reports → Version 1 posted 11 You are reading this latest preprint version Abstract Recent trends from Western countries indicate a stagnation of life expectancy gains, raising questions about the mechanismsthat sustain healthy aging and morbidity compression. In this study, we focus on trends in cardiovascular diseases and diabetesand their determinants, as relevant contributors to potential morbidity compression and, consequently, to increases in healthylife expectancy. Using data from the Behavioral Risk Factor Surveillance System (BRFSS) from 1990 to 2023, we apply apseudo-panel approach to analyze morbidity patterns across birth cohorts. The models account for covariates such as BMI,smoking, ethnicity, gender, income, and education, including relevant nonlinearities and interactions to capture heterogeneityin disease risk. Findings show no clear evidence of morbidity compression, particularly for diabetes, where disease risk atcomparable ages is higher among more recent generations. These results are largely explained by the growing presenceof behavioral and socioeconomic risk factors, such as overweight and low income, which disproportionately affect youngercohorts. Our study contributes to the growing literature documenting worsening population health trajectories in countries withadvanced medical systems and highlights the need for public health strategies that address both behavioral and structuraldeterminants to promote healthy aging. Health sciences/Diseases Health sciences/Endocrinology Health sciences/Health care Health sciences/Medical research Health sciences/Risk factors aging BRFSS cardiovascular diseases diabetes morbidity compression socioeconomic inequalities Full Text Additional Declarations No competing interests reported. Supplementary Files supplementary.pdf Cite Share Download PDF Status: Published Journal Publication published 16 Apr, 2026 Read the published version in Scientific Reports → Version 1 posted Editorial decision: Revision requested 10 Feb, 2026 Reviews received at journal 09 Feb, 2026 Reviews received at journal 19 Jan, 2026 Reviewers agreed at journal 16 Jan, 2026 Reviewers agreed at journal 08 Jan, 2026 Reviewers agreed at journal 07 Jan, 2026 Reviewers invited by journal 07 Jan, 2026 Editor invited by journal 20 Dec, 2025 Editor assigned by journal 17 Dec, 2025 Submission checks completed at journal 17 Dec, 2025 First submitted to journal 15 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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