Neck circumference as a predictor of all-cause mortality in middle-aged and older adults in rural Ecuador

Background Neck circumference (NC) has been associated with mortality secondary to cardiovascular diseases and other conditions. However, information on this association in the population at large is limited. We aimed to assess this association in community dwellers living in rural Ecuador.Methods Individuals aged >= 40 y who were enrolled in the population-based Three Villages Study cohort were prospectively followed to estimate mortality risk according to baseline measurements of NC, after adjusting for relevant confounders.Results Analysis included 1521 individuals followed for a mean of 6.4 +/- 3.4 y. Mean NC was 36.2 +/- 3.7 cm, with 509 (33%) individuals allocated to the first (25-34 cm), 319 (21%) to the second (36-37 cm), 417 (27%) to the third (37-39 cm) and 276 (18%) to the fourth (40-50 cm) quartile. A total of 211 (14%) individuals died during the follow-up. Overall, the crude mortality rate was 2.3 per 100 person-years, which increased to 5.63 for those in the fourth NC quartile. An adjusted Cox-proportional hazards model showed that individuals in the fourth quartile of NC had higher mortality risk compared with the first quartile (HR: 2.98; 95% CI 1.77 to 5.02).Conclusion Larger NC increases mortality risk in middle-aged and older adults of indigenous ancestry living in rural Ecuador.