Physical and biochemical predictors of death in an Australian aboriginal cohort

1. Predictors of natural and cardiovascular death were examined in a cohort from a remote Australian Aboriginal community with high mortality rates. The cohort was marked by high prevalences of diabetes (17%), hypertension (19% diastolic blood pressure (BP) > 90 mmHg), obesity (16% body mass index (BMI) > 30), albuminuria (26% albumin/creatinine ratio (ACR) > or = 34 g/mol) and renal failure (26% calculated glomerular filtration rate < 80 mL/min). 2. Relationships between baseline characteristics and subsequent mortality were examined using multivariate techniques. 3. Albuminuria, diabetes and hypertension (but not smoking dyslipidaemia or obesity) were all markers for increased risk of natural and especially of cardiovascular death. Age- and sex-adjusted relative risk [95% CI] of natural deaths were 4.3 [1.9-9.5] for overt albuminuria (ACR > or = 34, 3.2 (range 1.6-6.5) for diastolic BP > or = 100 and 3.7 (range 1.5-8.9) for diabetes. 4. The relative risk associated with albuminuria was independent of diabetes and hypertension. Albuminuria was more common than either diabetes or hypertension and represents a target for intervention to reduce not only progression to renal disease, but also overall mortality.