U-Shaped Association of Serum Uric Acid with All-cause and Cause-Specific Mortality in US Adults: A Cohort Study
Abstract
BACKGROUND
In addition to the controversy regarding the association of hyperuricemia with mortality, uncertainty also remains regarding the association between low serum uric acid (SUA) and mortality. We aimed to assess the relationship between SUA and all-cause and cause-specific mortality.
METHODS
This cohort study included 9,118 US adults from NHANES (1999-2002). Multivariable Cox proportional hazards models were used to evaluate the relationship between SUA and mortality. Our analysis included the use of a generalized additive model (GAM) and smooth curve fitting (penalized spline method), and two-piecewise Cox proportional hazards models, to address the nonlinearity between SUA and mortality.
RESULTS
During a median follow-up of 5.83 years, 448 all-cause deaths occurred, with 100 cardiovascular disease (CVD) deaths, 118 cancer deaths and 37 respiratory disease deaths. Compared to the reference group, there was a increased risk of all-cause, CVD, cancer and respiratory disease mortality for participants in the first and third tertile of SUA. We further found a nonlinear and U-shaped association between SUA and mortality. The inflection point for the curve was found at a SUA level of 5.7 mg/dL. The HRs (95%CIs) for all-cause mortality were 0.80 (0.65, 0.97) and 1.24 (1.10, 1.40) to the left and right of the inflection point, respectively. This U-shaped association was observed in both sexes; the inflection point for SUA was 6 mg/dL in males and 4 mg/dL in females.…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 9,118 participants or records.
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