Hemoglobin glycation index and all-cause mortality in adults: insights from a decade-long prospective cohort study

Abstract

Background: The hemoglobin glycation index (HGI), an indicator of individual differences in glucose metabolism. This study undertakes a detailed 10-year cohort analysis to investigate the potential association between HGI and all-cause mortality in a Chinese adult population.

Methods: Baseline data encompassing lifestyle and metabolic parameters were collected from 10,008 participants, with a subsequent 10-year follow-up. Following exclusions based on predefined criteria, 9,084 individuals were included in the final analysis. Participants were categorized into quartiles based on their HGI values. A suite of statistical tools, including Kaplan-Meier survival analysis, Cox proportional hazards models, restricted cubic splines (RCS), threshold effect models, and subgroup analyses, was employed to investigate the association between HGI and all-cause mortality.

Results: During the 10-year follow-up period, a total of 514 all-cause mortality cases were recorded. Kaplan-Meier survival analysis identified the Q2 group as having the lowest mortality rate. Fully adjusted Cox proportional hazards models demonstrated significant associations, indicating higher all-cause mortality risks in participants with both extremely low and high HGI levels compared to the Q2 group. RCS analysis further illustrated a U-shaped relationship between HGI and all-cause mortality.

Conclusions: In the Chinese population, both markedly elevated and significantly reduced HGI levels are associated with adverse impacts on long-term survival.

Core tip: The aim of this study was to assess the association of Hemoglobin Glycation Index(HGI) with all-cause mortality in non-type 2 diabetic patients based on a 10-year cohort study from China. After COX regression, restricted cubic spline analysis, and subgroup analyses, it was found that a significant increase or decrease in HGI adversely affected long-term survival.

Keywords: U-shaped correlation; all-cause mortality; hemoglobin glycation index; prospective cohort study; risk fcator.

Figure 1

(A) Kaplan-Meier all-cause mortality survival analysis curve; (B) Results of RCS analysis of the association between HGI and all-cause mortality. Adjusted for age, sex, DBP, SBP, LDL-c, HDL-c, TG, TC, Cr, FBG, HbA1c, smoking status, alcohol consumption, and education level.

Figure 2

Forest plot of subgroup analyses of the relationship between HGI and all-cause mortality. Adjusted for age, sex, DBP, SBP, LDL-c, HDL-c, TG, TC, Cr, FBG, HbA1c, smoking status, alcohol consumption, and education level.