Stress Hyperglycemia Ratio as a Predictor of All-Cause and Cardiovascular Mortality in Patients With Urinary Incontinence: Evidence From NHANES 2001–2018

Background: The stress hyperglycemia ratio (SHR) is a potential marker of stress-related glucose dysregulation and adverse health outcomes. However, its association with mortality risk in individuals with urinary incontinence (UI) remains poorly understood. Objective: This study aimed to evaluate the relationship between SHR and mortality risk in adults with UI, specifically examining its role as a predictor of all-cause and cardiovascular mortality. Methods: We analyzed data from 5,933 adults with UI from the NHANES 2001–2018 cohort, with mortality follow-up through 2019. SHR was categorized into quartiles. Survival differences were assessed using Kaplan-Meier curves and log-rank tests. Cox proportional hazards models were applied with stepwise adjustments for potential confounders. Nonlinear trends were explored using restricted cubic spline regression, and subgroup analyses evaluated potential effect modifications. Results: A U-shaped association was observed between SHR and both all-cause and cardiovascular mortality. Optimal thresholds for SHR were 0.829 for all-cause mortality and 0.850 for cardiovascular mortality. Participants in the highest SHR quartile had a 27% increased risk of all-cause mortality (HR = 1.27, 95% CI: 1.05–1.53) after full adjustment. Mortality risk escalated sharply beyond these thresholds (7.20-fold for all-cause mortality, 95% CI: 4.36–11.90; 8.90-fold for cardiovascular mortality, 95% CI: 4.55–17.41). The association was stronger in males (P = 0.04) and other Hispanic subgroups (P = 0.03). Conclusions: SHR was an independent predictor of mortality risk in adults with UI. This finding suggests that SHR may serve as a useful biomarker for identifying high-risk individuals and guiding early interventions to reduce mortality in this population.