Associations Of Urinary Albumin-to-creatinine Ratio With Cognitive Status And Mortality Risk In The Elderly In China

ObjectiveThis study collected the baseline data of the elderly aged 65 years and above from 9 longevity areas in China and followed up the cognitive function status and survival outcomes,and analyzed the correlation between the urinary albumin-to-creatinine ratio of Chinese elderly people and the occurrence of cognitive impairment and all-cause mortality.To explore the effect of the urinary albumin-to-creatinine ratio on the cognitive status and mortality risk of the Chinese elderly.MethodsThis study used data from the Healthy Aging and Biomarkers Cohort Study(HABCS).Older adults recruited from 2012 to 2018 were included in this study.According to the collected urine microalbumin and urine creatinine values,the urinary albumin-to-creatinine ratio(urine microalbumin/urine creatinine)was calculated.The data on cognition,survival,and time of death were collected.According to the urinary albumin-to-creatinine ratio,they were divided into four subgroups according to the quartile,and Q1 was used as the reference group.Cox proportional hazards models were used to estimate the association between the urinary albumin-to-creatinine ratio and cognitive impairment and risk of death.The interaction between age,gender and the urinary albumin-to-creatinine ratio was analyzed by likelihood ratio test.Results1.A total of 1315 subjects were included in the section on urinary albumin-to-creatinine ratio and cognitive impairment,the age of subjects M(P25,P75)was 74(61,87)years old,including 575 females(43.7%).A total of 653 participants developed cognitive impairment during the 6-year follow-up period.The incidence density of cognitive impairment was 134.2 per 1000 person-years.Cox proportional hazard model analysis showed that compared with the Q1 group(UACR<1.48mg/g),The hazard ratio of the Q2 group(1.48mg/g≤UACR<5.20mg/g),Q3 group(5.20mg/g≤UACR<15.32mg/g)and Q4 group(15.32mg/g≤UACR)are 1.80(1.40,2.32%1.87(1.45,2.40),2.07(1.60,2.68)(all P≤0.001)respectively.Stratified analysis showed that there was no significant association between urinary albumin-to-creatinine ratio and cognitive impairment in different age groups(P for interaction=0.895).There was no significant association between urinary albumin-to-creatinine ratio and cognitive impairment in different genders(P for interaction=0.716).2.A total of 2345 subjects were included in the section on urinary albumin-to-creatinine ratio and all-cause mortality,the age of subjects M(P25,P75)was 88(68,108)years old,including 1328 females(56.6%).A total of 680 participants died during the 6-year follow-up period,yielding a mortality density of 86.9 deaths per 1000 person-years.Cox proportional hazards regression model showed that compared with the Q1 group(UACR<2.87mg/g),the hazard ratio of the Q3 group(8.23mg/g≤UACR<27.00mg/g)and Q4 group(27.00mg/g≤UACR)are 1.38(1.09,1.75)(P≤0.01),1.51(1.19,1.90)(P≤0.001),respectively.There was no significant difference between the Q2 group(2.87mg/g≤UACR<8.23mg/g)and the Q1 group(P=0.09).The main stratification variables showed that there was no significant association between urinary albumin-to-creatinine ratio and all-cause mortality in different age groups(P for interaction=0.163).There was no gender difference in the association between urinary albumin-to-creatinine ratio and all-cause mortality(P for interaction=0.248).ConclusionHigh levels of urinary microalbumin-to-creatinine ratio are associated with higher risks of cognitive impairment and all-cause mortality in the elderly,and the effect of urinary microalbumin-to-creatinine ratio on the risk of cognitive impairment was stronger among the male elderly.