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Each 1-SD increment in cum RHR was associated with a 37% (HR: 1.37, 95% CI: 1.23–1.52) increased risk of death and displayed a J-shaped relationship.

Compared with no exposure, adults who had a higher RHR at all 3 study visits were associated with a 1.86-fold higher risk (95% CI: 1.33–2.61) of mortality.

The trend was statistically significant only in men (P trend = 0.037). The HR for cum RHR with all-cause mortality initially decreased at the lowest quartile, then increased somewhat in the second-lowest quartile, with a higher degree of increase at the upper distributions of cum RHR, producing a J-shaped relationship.

There was no significant interaction between cum RHR and sex in relation to all-cause mortality as either a continuous or categorical variable (P interaction for both The HR (95% CI) for all-cause mortality was estimated using multivariable Cox regression model with the restricted cubic spline for cum RHR. There was significant non-linear term for cum RHR (P Figure 3: Hazard ratios and 95% confidence intervals for cum RHR with all-cause mortality by using restricted cubic spline regression with three knots with placed at the 25th, 50th, and 75th percentiles of cum RHR, and the red line represented HR and blue lines represented 95% CI.

In the current analysis, we used data from the baseline to the third examination in the Kailuan cohort study to calculate the cum RHR and to explore the association between cum RHR, the number of visits with a higher RHR and any cause of death.

We also test whether there were sex-related differences.

From the lowest cum RHR quartile to the highest, the mortality rate increased from 35.60 to 42.05, 52.94 and 90.91 per 10,000 person-years, respectively.

Figure 2(a) shows the Kaplan-Meier mortality rate by the quartile of cum RHR.

Of a total of 101,510 individuals in the original cohort, 57,927 participants completed the second and third examinations consecutively.Men in the highest quartile of cum RHR had a 1.40-fold (95% CI: 1.07–1.84) greater risk of all-cause mortality versus the lowest cum RHR quartile.However, the association was not statistically significant among women.The baseline characteristics of the 8,930 subjects with missing RHR data were different from the remaining 47,311 adults.The excluded participants were slightly older, more female, had a lower baseline systolic blood pressures, and had a lower proportion of smokers, alcohol users, hypertensives and diabetics (all P The average cum RHR ± SD was 298.66 ± 46.79 [(beats/min) * year], with a range from 156 to 698 [(beats/min) * year].

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