ArticleMedicine2026
Nonlinear association between the erythrocyte distribution width-to-albumin ratio and mortality in older adults: A retrospective cohort study using NHANES 1999 to 2018 data.
Article in Medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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4 authors.
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Abstract
Older adults face high risks of all-cause and cardiovascular disease (CVD) mortality; however, simple, inexpensive biomarkers for early risk identification are limited. The red cell distribution width-to-albumin ratio (RAR) is a low-cost, routinely measured marker, but its prognostic value in older adults is unclear. We examined whether RAR is independently associated with all-cause and CVD mortality in older adults. We conducted a retrospective cohort study using data from the United States National Health and Nutrition Examination Survey (1999-2018). The study included 16,558 adults aged ≥60 years, with median follow-up of 9.4 years. Multivariable Cox proportional hazards models estimated associations between RAR and mortality. Nonlinearity was evaluated using generalized additive models with penalized splines and two-piecewise Cox models combined with a recursive algorithm. Among 16,558 participants (mean age 70.7 ± 7.3 years; 49.8% men), RAR quartiles were Q1 (2.32-2.95), Q2 (2.95-3.16), Q3 (3.16-3.45), and Q4 (>3.45). Over a median 9.4-year follow-up, 6119 deaths occurred, including 2048 CVD deaths. In fully adjusted models, RAR was associated with greater risks of all-cause mortality (hazard ratio = 2.15, 95% confidence interval = 1.89-2.45) and CVD mortality (hazard ratio = 2.05, 95% confidence interval = 1.74-2.41). Associations were nonlinear, with a threshold at RAR = 4.05; below this level, higher RAR was linked to increased all-cause and CVD mortality, whereas above it, the association weakened and CVD mortality risk plateaued. RAR was independently and nonlinearly associated with all-cause and CVD mortality in older adults. These findings support RAR as a simple biomarker for mortality risk identification in older adults.
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