Cardiometabolic Mortality and Health System Expansion in Kuwait (2010-2022): A National Time-Series Analysis

Background: Cardiometabolic diseases are a leading cause of premature mortality globally, yet longitudinal national mortality patterns remain insufficiently characterised in Gulf Cooperation Council settings. This study examines national trends in cardiometabolic mortality alongside health system financing, capacity, and utilization in Kuwait between 2010 and 2022. Methods: A national ecological time-series analysis used Ministry of Health administrative data covering mortality, cardiac care unit (CCU) capacity and discharges, cardiovascular procedural volumes, and MOH expenditure. Cause-specific outcomes included circulatory disease, ischaemic heart disease (IHD), cerebrovascular disease, hypertensive disease, and diabetes mellitus. Ordinary least squares regression estimated annual trends; pre-COVID restricted models (2010-2019) separated secular from pandemic-period effects. Results: All-cause deaths rose significantly from 5448 (2010) to 8041 (2022; β = +373.5/year; p = 0.001), peaking at 10,938 in 2021. Circulatory disease mortality rates increased over the full series but not pre-COVID, indicating pandemic-era acceleration. IHD death counts rose significantly in both models (β = +68.4 and +67.0/year; p < 0.01); IHD rates showed no significant trend, implicating demographic growth. Diabetes demonstrated the strongest signal: significant increases in death counts (β = +36.5/year; p < 0.001) and mortality rates (β = +0.689/100,000/year; p = 0.002), rising progressively across all time blocks. Hypertensive mortality declined significantly (β = -0.113/year; p = 0.002). MOH expenditure, CCU capacity, and CCU discharges increased significantly, demonstrating sustained structural expansion of cardiovascular services. Conclusions: Rising cardiometabolic mortality-driven prominently by diabetes-occurred alongside sustained health system expansion in Kuwait, indicating that tertiary capacity growth alone is insufficient to offset underlying epidemiological pressures. These findings underscore the urgency of strengthening upstream cardiometabolic prevention, integrated diabetes surveillance, and long-term metabolic risk control as central pillars of sustainable NCD policy.