Peripheral neuropathy independently associated with mortality risk: Study

The American Diabetes Association has issued multiple recommendation statements about diabetic neuropathies and the care of the diabetic foot. Given that approximately 50% of adults with diabetes will be affected by peripheral neuropathy in their lifetime, more diligent screening and management are important to reduce the complications and health care burden associated with the disease. Peripheral neuropathy (PN) is common in the general US adult population, especially in older adults even in the absence of diabetes. However, the clinical sequelae of Peripheral Neuropathy (PH) have not been quantified in the general population. Researchers of Baltimore assessed the associations of prevalent PN with all-cause and cardiovascular mortality using data from the National Health and Nutrition Examination Survey(NHANES) 1999 to 2004.

It was a prospective cohort analysis of 7,137 participants from NHANES (aged ≥40 yrs) who underwent standardized monofilament testing for PN testing at baseline (1999-2004). Researchers evaluated the association of PN with all-cause and cardiovascular mortality using survival analysis methods and Cox regression. Cox models were adjusted for demographic and cardiovascular risk factors.

After analysis, the researchers found the overall prevalence of Peripheral Neuropathy was 13.5% ± 0.5% (27.0% ± 1.4% in adults with diabetes and 11.6% ± 0.5% in adults without diabetes). During a median follow-up of 13 years, they reported 2128 death, among which 488 were from cardiovascular causes. Incidence rates of all-cause mortality were 57.6 in adults with diabetes and PN, 34.3 in adults with PN but no diabetes, 27.1 in adults with diabetes but no PN, and 13.0 in adults with no diabetes and no PN. In adjusted models, they found a significant association between PN and all-cause mortality (hazard ratio [HR] 1.49) and cardiovascular mortality (HR, 1.66) in participants with diabetes. In those without diabetes, they found PN was significantly associated with all-cause mortality (HR 1.31). However, the association between PN and cardiovascular mortality was not statistically significant after adjustment (HR 1.27).

The authors concluded, "Peripheral neuropathy was common and was independently associated with mortality in the U.S. population, even in the absence of diabetes. These findings suggest that decreased sensation in the foot may be an under-recognized risk factor for death in the general population".

For further information:

https://www.acpjournals.org/doi/full/10.7326/M20-1340