Reynolds Evan L, Russman David, Elafros Melissa A, Feldman Eva L, Callaghan Brian C
Department of Epidemiology and Biostatistics, Michigan State University, East Lansing; and.
Department of Neurology, University of Michigan, Ann Arbor.
Neurology. 2025 Aug 12;105(3):e213851. doi: 10.1212/WNL.0000000000213851. Epub 2025 Jul 16.
Peripheral neuropathy (PN) is a morbid condition. In the United States, there is higher prevalence of PN in non-Hispanic Black and Hispanic individuals vs non-Hispanic White individuals. Underlying mechanisms driving this increased prevalence are unknown. We aimed to determine associations between PN and race/ethnicity; other demographic information; and metabolic, lifestyle, and social determinants of health (SDOH) risk factors in a large and diverse sample of adults from the United States.
We performed a cross-sectional secondary analysis of the National Health and Nutrition Examination Survey from 1999 to 2004. PN was assessed using a monofilament test of reduced sensation. Risk factors included demographic (age, sex, race/ethnicity), metabolic (height, weight, waist circumference, systolic blood pressure, high-density lipoproteins, HbA1c), lifestyle (physical activity, diet), and SDOH (food security, household income, health insurance) information.
The study included 8,014 individuals (55% non-Hispanic White, 18% non-Hispanic Black, 24% Hispanic, 3% other). The mean (SD) age was 60.8 (13.3) years, and 50% were female. Logistic regression revealed that non-Hispanic Black (odds ratio: 1.39, 95% CI 1.16-1.66) and Hispanic (1.31, 1.11-1.54) individuals had higher age-adjusted and sex-adjusted odds of PN than White individuals. Male individuals had higher age-adjusted and race-adjusted odds of PN than female individuals (0.55, 0.48-0.63). After adjusting for metabolic, lifestyle, and SDOH factors, we found that non-Hispanic Black individuals had similar odds of PN to White individuals (1.17, 0.93-1.46, = 0.17) and male individuals (0.83, 0.66-1.05, = 0.12) had similar odds of PN to female individuals. However, Hispanic individuals maintained a higher likelihood of PN (1.32, 1.07-1.63, = 0.001) after adjusting for these comprehensive risk factors. Among individual risk factors, we found that age (1.05, 1.04-1.06), height (1.03, 1.02-1.05), HbA1c (1.13, 1.06-1.21), waist circumference (1.011, 1.005-1.017), and lack of health insurance (1.49, 1.16-1.92) were associated with PN. In stratified analyses, among Hispanic individuals, we found that the percentage of caloric intake from saturated fatty acids (1.06, 1.01-1.10) and food insecurity (1.48, 1.06-2.05) were associated with PN.
We found that PN risk factors likely explain higher PN prevalence in non-Hispanic Black individuals but not among Hispanic individuals. We also determined SDOH risk factors-including being uninsured, and, in Hispanic individuals, experiencing food insecurity-increased the odds of PN, indicating the need for screening, prevention, and treatment of PN in persons with SDOH risk factors.
周围神经病变（PN）是一种病态状况。在美国，非西班牙裔黑人及西班牙裔个体中PN的患病率高于非西班牙裔白人个体。导致这种患病率增加的潜在机制尚不清楚。我们旨在确定在美国一个大型且多样化的成年样本中，PN与种族/族裔、其他人口统计学信息以及代谢、生活方式和社会健康决定因素（SDOH）风险因素之间的关联。
我们对1999年至2004年的国家健康与营养检查调查进行了横断面二次分析。使用单丝感觉减退测试评估PN。风险因素包括人口统计学（年龄、性别、种族/族裔）、代谢（身高、体重、腰围、收缩压、高密度脂蛋白、糖化血红蛋白）、生活方式（身体活动、饮食）以及SDOH（粮食安全、家庭收入、医疗保险）信息。
该研究纳入了8014名个体（55%为非西班牙裔白人，18%为非西班牙裔黑人，24%为西班牙裔，3%为其他）。平均（标准差）年龄为60.8（13.3）岁，50%为女性。逻辑回归显示，非西班牙裔黑人（比值比：1.39，95%置信区间1.16 - 1.66）和西班牙裔（1.31，1.11 - 1.54）个体比白人个体具有更高的年龄和性别调整后的PN患病几率。男性个体比女性个体具有更高的年龄和种族调整后的PN患病几率（0.55，0.48 - 0.63）。在调整代谢、生活方式和SDOH因素后，我们发现非西班牙裔黑人个体的PN患病几率与白人个体相似（1.17，0.93 - 1.46，P = 0.17），男性个体的PN患病几率与女性个体相似（0.83，0.66 - 1.05，P = 0.12）。然而，在调整这些综合风险因素后，西班牙裔个体仍具有较高的PN患病可能性（1.32，1.07 - 1.63，P = 0.001）。在个体风险因素中，我们发现年龄（1.05，1.04 - 1.06）、身高（1.03，1.02 - 1.05）、糖化血红蛋白（1.13，1.06 - 1.21）、腰围（1.011，1.005 - 1.017）以及缺乏医疗保险（1.49，1.16 - 1.92）与PN相关。在分层分析中，在西班牙裔个体中，我们发现饱和脂肪酸热量摄入百分比（1.06，1.01 - 1.10）和粮食不安全（1.48，1.06 - 2.05）与PN相关。
我们发现PN风险因素可能解释了非西班牙裔黑人个体中较高的PN患病率，但在西班牙裔个体中并非如此。我们还确定了SDOH风险因素，包括未参保，以及在西班牙裔个体中经历粮食不安全，会增加PN的患病几率，这表明需要对有SDOH风险因素的人群进行PN的筛查、预防和治疗。
