Prevalence of peripheral neuropathy defined by monofilament insensitivity in middle-aged and older adults in two US cohorts

Abstract

Peripheral neuropathy is associated with substantial morbidity, but risk factors other than diabetes are largely uncharacterized. The aim of this study was to describe the prevalence and risk factors for peripheral neuropathy in adults with and without diabetes from two different population-based studies in the US. We performed a cross-sectional analysis of 5200 black and white participants from NHANES (1999-2004, age 40-85 years) and 3362 black and white participants from the ARIC Study (2016-2017, age 70-89 years) who underwent monofilament testing for peripheral neuropathy using a shared protocol. We used logistic regression to quantify age, sex, and race-adjusted risk factor associations for peripheral neuropathy among middle-aged (40-69 years) and older (≥ 70 years) adults. The age, sex, and race-adjusted prevalence of peripheral neuropathy (decreased sensation on monofilament testing) was 10.4% for middle-aged adults in NHANES, 26.8% for older adults in NHANES, and 39.2% for older adults in ARIC. Diabetes was an important risk factor, but more strongly associated with peripheral neuropathy in middle-aged (OR ~ 5 for long-standing diabetes) compared to older adults (ORs ~ 1.5-2). Male sex (ORs ~ 2), black race (ORs ~ 1.3-1.5), and greater height (ORs ~ 1.5-3) were robust risk factors for peripheral neuropathy. Other risk factors included body mass index, education, and peripheral artery disease. The burden of peripheral neuropathy defined by abnormal monofilament testing among older adults is substantial, even among adults without diabetes. Studies are needed to understand the etiology and prognosis of peripheral neuropathy in the absence of diabetes.

Figure 1

Age, sex, and race-adjusted prevalence of peripheral neuropathy stratified by diabetes status in US adults aged 40–69 and ≥ 70 years (NHANES, 1999–2004) and ARIC participants aged ≥ 70 years (Visit 6, 2016–2017).

Figure 2

Association of peripheral neuropathy with duration of diabetes among US adults aged 40–69 (panel A) and ≥ 70 years (panel B) (NHANES, 1999–2004) and ARIC participants aged ≥ 70 years (panel C) (Visit 6, 2016–2017). Adjusted associations for duration of diabetes with peripheral neuropathy in ARIC (2016–2017) and NHANES (1999–2004).Odds ratios were from logistic regression models adjusted for age, sex and race. Duration of diabetes was modelled as a categorical variable: 0–4 years, 5–14 years, 15–24 years and 25 years and more. Odds ratios and 95% confidence intervals were plotted at the median of each diabetes duration category.