Abstract Body: Objectives:
Peripheral neuropathy (PN) is common in older adults, even in the absence of diabetes. The association of PN with mortality in older adults is poorly characterized. We aimed to assess the association of advanced PN with mortality in community-dwelling adults aged 70-95 years.

Methods:
We conducted a prospective cohort analysis of participants in the Atherosclerosis Risk in Communities (ARIC) Study who underwent the 5.07 Semmes–Weinstein nylon monofilament insensitivity test for PN between 2016 and 2017 (ARIC Visit 6). Advanced PN was defined as lack of sensation at one or more foot sites during the monofilament test. We used Kaplan Meier survival analyses to estimate crude differences in all-cause mortality by PN status, and Cox regression models adjusting for demographics and clinical factors to quantify the association of advanced PN with all-cause mortality, overall and stratified by diabetes status.

Results:
Among 3,501 participants (median age 79 years; 41% male; 21% Black; 35% with diabetes, median follow up time 4.0 years), 34% had advanced PN. Estimated 5-year mortality was 25.5% (95%CI 23.0%–28.0%) in individuals with advanced PN and 14.2% (95%CI: 12.7%–15.6%) in those without PN (P<0.001). Participants with advanced PN had higher all-cause mortality compared to participants without PN regardless of diabetes status (Log-rank P<0.001; Figure). After risk adjustment, advanced PN was associated with a higher risk of all-cause mortality overall (HR 1.33, 95%CI 1.15–1.55) and among participants without diabetes (HR 1.53, 95%CI 1.26–1.87). However, the association of PN with mortality was no longer significant among participants with diabetes (HR 1.10, 95%CI 0.87–1.38; P-value for interaction = 0.01).

Conclusions:
Older adults with advanced PN detected by monofilament testing have a higher risk of all-cause mortality compared to older adults without advanced PN, particularly among patients without diabetes. Reduced foot sensation may be an important screening tool for mortality risk in older individuals regardless of their diabetes status.