Red blood cell distribution width and all-cause mortality in low-income populations: a NHANES-based cohort study.
5 affiliations
- 1Department of Laboratory Medicine, Fifth People's Hospital of Kunshan, Suzhou, China.
- 2Department of Laboratory Center, The Second Affiliated Hospital, Henan University of Traditional Chinese Medicine, Zhengzhou, China.
- 3Department of Intensive Care Medicine, First Affiliated Hospital of Jiamusi University, Jiamusi, China.
- 4Suzhou Bozhong Semiconductor Co., Ltd., Suzhou, China.
- 5Department of Urology, Fifth People's Hospital of Kunshan, Suzhou, China.
Abstract
Background
Red blood cell distribution width (RDW) may be associated with all-cause mortality. This study aimed to evaluate the relationship between RDW and all-cause mortality in low-income populations. Low-income status was defined as a Family Income to Poverty Ratio (PIR) < 1, consistent with previous studies. All analyses were weighted to account for the complex sampling design.Methods
This study included 92,062 adults from the National Health and Nutrition Examination Survey (NHANES) 1999-2016 database, with survival follow-up through December 31, 2016. Analyses were restricted to the low-income subgroup and weighted according to the NHANES sampling design to ensure national representativeness. Linear and nonlinear multivariable Cox regression models were used to evaluate the association between RDW and all-cause mortality. Participants with missing data were excluded through complete-case analysis. Statistical analyses were performed using EmpowerStats and R software.Results
A total of 17,412 participants were included in the final analysis. In the low-income population, RDW showed a nonlinear association with all-cause mortality, characterized by a threshold at 15.9%. Below this threshold, each 1% increase in RDW was associated with a 29% higher risk of mortality (HR = 1.29, 95% CI: 1.20-1.38, P < 0.0001), while above 15.9%, the association was no longer statistically significant. Multivariable Cox regression analysis demonstrated that RDW remained significantly associated with mortality after adjustment for potential confounding factors (hazard ratio [HR] = 1.11, 95% confidence interval [CI]: 1.08-1.15, P < 0.0001). Specifically, each 1% increase in RDW was associated with an 11% increase in the risk of all-cause mortality.Conclusion
Elevated RDW was associated with increased all-cause mortality among low-income adults and may indicate a potential prognostic marker for mortality risk in this vulnerable population. However, further studies are needed to validate its clinical predictive utility.
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BibTeX
@article{ma2026blood,
title = {{Red blood cell distribution width and all-cause mortality in low-income populations: a NHANES-based cohort study.}},
author = {Hui Ma and Yu-Han Li and Jin-Da Zhao and Yu-Wei Gu and Ren-Tao Zhu},
journal = {Frontiers in epidemiology},
year = {2026},
month = oct,
doi = {10.3389/fepid.2026.1746886},
url = {https://europepmc.org/article/MED/42948113},
note = {CC BY},
}
RIS
TY - JOUR
TI - Red blood cell distribution width and all-cause mortality in low-income populations: a NHANES-based cohort study.
AU - Hui Ma
AU - Yu-Han Li
AU - Jin-Da Zhao
AU - Yu-Wei Gu
AU - Ren-Tao Zhu
PY - 2026
DA - 2026/10/13
JO - Frontiers in epidemiology
DO - 10.3389/fepid.2026.1746886
UR - https://europepmc.org/article/MED/42948113
AB - Background Red blood cell distribution width (RDW) may be associated with all-cause mortality. This study aimed to evaluate the relationship between RDW and all-cause mortality in low-income populations. Low-income status was defined as a Family Income to Poverty Ratio (PIR) < 1, consistent with previous studies. All analyses were weighted to account for the complex sampling design.Methods This study included 92,062 adults from the National Health and Nutrition Examination Survey (NHANES) 1999-2016 database, with survival follow-up through December 31, 2016. Analyses were restricted to the low-income subgroup and weighted according to the NHANES sampling design to ensure national representativeness. Linear and nonlinear multivariable Cox regression models were used to evaluate the association between RDW and all-cause mortality. Participants with missing data were excluded through complete-case analysis. Statistical analyses were performed using EmpowerStats and R software.Results A total of 17,412 participants were included in the final analysis. In the low-income population, RDW showed a nonlinear association with all-cause mortality, characterized by a threshold at 15.9%. Below this threshold, each 1% increase in RDW was associated with a 29% higher risk of mortality (HR = 1.29, 95% CI: 1.20-1.38, P < 0.0001), while above 15.9%, the association was no longer statistically significant. Multivariable Cox regression analysis demonstrated that RDW remained significantly associated with mortality after adjustment for potential confounding factors (hazard ratio [HR] = 1.11, 95% confidence interval [CI]: 1.08-1.15, P < 0.0001). Specifically, each 1% increase in RDW was associated with an 11% increase in the risk of all-cause mortality.Conclusion Elevated RDW was associated with increased all-cause mortality among low-income adults and may indicate a potential prognostic marker for mortality risk in this vulnerable population. However, further studies are needed to validate its clinical predictive utility.
SN - 2674-1199
ER -