Fibroblast Growth Factor 23 and Cause-Specific Mortality in the General Population: The Northern Manhattan Study

J Clin Endocrinol Metab. 2016 Oct;101(10):3779-3786. doi: 10.1210/jc.2016-2215. Epub 2016 Aug 8.


Context: An elevated fibroblast growth factor (FGF) 23 is an independent risk factor for cardiovascular disease and mortality in patients with kidney disease. The relationship between FGF23 and cause-specific mortality in the general population is unknown.

Objective: To investigate the association of elevated FGF23 with the risk of cause-specific mortality in a racially and ethnically diverse urban general population.

Design, setting, participants: The Northern Manhattan Study is a population-based prospective cohort study. Residents who were > 39 years old and had no history of stroke were enrolled between 1993 and 2001. Participants with available blood samples for baseline FGF23 testing were included in the current study (n = 2525).

Main outcome measures: Cause-specific death events.

Results: A total of 1198 deaths (474 vascular, 612 nonvascular, 112 unknown cause) occurred during a median follow-up of 14 years. Compared to participants in the lowest FGF23 quintile, those in the highest quintile had a 2.07-fold higher risk (95% confidence interval [CI], 1.45, 2.94) of vascular death and a 1.64-fold higher risk (95% CI, 1.22, 2.20) of nonvascular death in fully adjusted models. Higher FGF23 was independently associated with increased risk of mortality due to cancer, but only in Hispanic participants (hazard ratio per 1 unit increase in ln FGF23 of 1.87; 95% CI, 1.40, 2.50; P for interaction = .01).

Conclusions: Elevated FGF23 was independently associated with increased risk of vascular and nonvascular mortality in a diverse general population and with increased risk of cancer death specifically in Hispanic individuals.

MeSH terms

  • Adult
  • African Continental Ancestry Group / ethnology
  • Aged
  • Aged, 80 and over
  • Cause of Death*
  • European Continental Ancestry Group / ethnology
  • Female
  • Fibroblast Growth Factors / blood*
  • Follow-Up Studies
  • Hispanic Americans / statistics & numerical data*
  • Humans
  • Male
  • Middle Aged
  • Neoplasms* / blood
  • Neoplasms* / ethnology
  • Neoplasms* / mortality
  • New York City / ethnology
  • Risk Factors
  • Urban Population / statistics & numerical data
  • Vascular Diseases* / blood
  • Vascular Diseases* / ethnology
  • Vascular Diseases* / mortality


  • Fibroblast Growth Factors
  • fibroblast growth factor 23