In a retrospective cohort of 910 adults aged 60 and older (mean age 71; 67% female) followed from 2020 to 2024, both low handgrip strength (HR 1.91) and highest-quartile uric acid levels (HR 1.86) predicted all-cause mortality in unadjusted models. After multivariable correction, however, only hyperuricemia retained independent predictive power — and exclusively in women, where it carried a striking hazard ratio of 3.08 (95% CI 1.31–7.26). Grip strength's association did not survive adjustment.
The sex-specific finding is the headline result here. Uric acid's prognostic role has been contested for years: it correlates with gout, cardiovascular disease, and kidney dysfunction, yet its independent mortality signal often dissolves after controlling for metabolic confounders. This study suggests that in older women — who have lower baseline uric acid thresholds and lose estrogen-mediated uricosuric protection post-menopause — elevated uric acid may be a more meaningful risk marker than in men. That mechanistic logic is plausible and fits emerging literature on sex-differentiated urate physiology.
Limitations are real: this is a single-centre retrospective cohort in Turkey, relatively small (910 participants), with follow-up under five years and a majority-female sample that limits generalisability to men. Confounding by comorbidity burden, diet, and diuretic use is hard to eliminate fully. Still, the finding argues practically for sex-stratified uric acid thresholds in geriatric screening — an incremental but clinically actionable refinement.
