Abstract P300: Peripheral Neuropathy is Associated With All-Cause Mortality Among Older Adults in the Atherosclerotic Risk in Communities Study

Abstract

Background: Peripheral neuropathy (PN) as assessed by monofilament testing (decreased sensation in the foot) is associated with mortality. The mechanisms by which PN increases mortality risk are unclear but may be partially explained by fall risk, a major contributor to morbidity and mortality in older adults. Hypothesis: We aimed to assess the hypothesis that PN is associated with all-cause mortality in older adults, and that this association may be partially explained by increased susceptibility to falls. Methods: We conducted a prospective cohort analysis of 3371 Black and White participants in the Atherosclerosis Risk in Communities (ARIC) study who underwent standardized monofilament PN testing at visit 6 (2016-2017; age 71-94 years). We used Cox models to assess the associations of PN with mortality before and after accounting for the intervening occurrence of injurious falls or fractures as identified using hospitalization discharge codes. Results: At visit 6, PN was prevalent in 34.6% of participants (overall mean age 79.4±4.7 years, 58.7% female, 20.9% Black, 32.5% had diabetes). During a median of 2.6 years of follow-up there were 602 falls or fractures (PN=22% vs. no PN=16%) and 219 deaths (PN=9.8% vs. no PN=4.8%). All-cause mortality was higher among older adults with PN (P<0.001; Figure ). In adjusted models, PN was significantly associated with all-cause mortality (HR 1.37, 95%CI 1.03-1.82), and this association was not attenuated after additionally adjusting for incident injurious falls or fractures (HR 1.37, 95%CI 1.03-1.81) or fractures alone (HR 1.37, 95%CI 1.03-1.82). Conclusion: PN was independently associated with all-cause mortality in older adults, but this association was not mediated by the intervening occurrence of injurious falls or fractures. These findings suggest that monofilament screening may provide critical prognostic information for mortality that is unrelated to fall risk.