{
  "abstract": "BackgroundPeripheral artery disease (PAD) is studied either through individual-level cohorts or national mortality statistics; the two evidence streams carry different biases and have not been formally compared within one design.\n\nMethodsWe triangulated two pre-specified streams. Individually, we analyzed 3,268 NHANES 1999-2004 participants aged 40 years and older with ankle-brachial index measurements (235 with PAD) linked to mortality through 2019, using survey-weighted logistic and Cox models, a Fine-Gray model, and attributable fractions. Ecologically, we used national Multiple Cause of Death records for 1999-2024 (390,174 PAD deaths) to estimate five-year-band trends in the share of PAD deaths mentioning tobacco (F17.0-F17.9), diabetes (E00-E89), or renal failure (N17-N19). Per a pre-specified protocol, we compared directions of association, each bridge quantified by a bootstrap direction-agreement probability.\n\nResultsWeighted PAD prevalence was 5.05% (95% CI, 4.18 to 5.92). PAD was associated with cardiovascular death (hazard ratio, 2.65; 95% CI, 1.87 to 3.76). Smoking showed the strongest PAD association (odds ratio, 3.37) and the steepest rise in its mortality share (2.20% to 18.50%; direction-agreement probability, 1.000). Diabetes was associated with PAD (1.68) and rose after a 2014 trough (7.35% to 10.92%; probability, 1.000). Renal failure was associated with PAD (1.78) but its mortality share was flat for 26 years (14.55% to 14.49%; probability, 0.445).\n\nConclusionsThe two streams agreed in direction for smoking and diabetes and diverged for kidney disease, reflecting different estimands. Smoking and diabetes are the factors supported by both streams for population-level PAD prevention.",
  "abstract_shown": true,
  "affiliations": [
    "Peking University First Hospital Taiyuan Hospital"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 4,
  "authors": [
    {
      "name": "Y. Zhang"
    },
    {
      "name": "J. Shi"
    },
    {
      "name": "R. Wu"
    },
    {
      "affs": [
        0
      ],
      "name": "F. Zhao"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/12pqnj45d1ay2.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.10.19.26365959",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.10.19.26365959v1.full",
  "id": "12pqnj45d1ay2",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.10.19.26365959v1",
  "language": null,
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "epidemiology"
    ],
    [
      "openalex",
      "2746|Peripheral Artery Disease Management"
    ]
  ],
  "openalex": "W7223247612",
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.10.19.26365959v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-19",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/12pqnj45d1ay2.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:21:30Z",
      "native_id": "10.64898/2026.10.19.26365959",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.10.19.26365959v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:epidemiology",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Individual-ecological triangulation of risk factors for peripheral artery disease: concordant evidence for smoking and diabetes, discordant evidence for kidney disease",
  "title_text": "Individual-ecological triangulation of risk factors for peripheral artery disease: concordant evidence for smoking and diabetes, discordant evidence for kidney disease",
  "type": "preprint",
  "updated_at": "2026-10-30T12:21:30Z",
  "url": "https://research.draconitic.com/paper/12pqnj45d1ay2",
  "venue": "medRxiv",
  "versions": []
}