Racial and Ethnic Differences in Peripheral Neuropathy Risk Factors Among United States Adults

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, p = 0.17) and male individuals (0.83, 0.66-1.05, p = 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, p = 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.