Department of Surgical Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.
Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China.
Front Endocrinol (Lausanne). 2024 Apr 22;15:1383516. doi: 10.3389/fendo.2024.1383516. eCollection 2024.
We aimed to assess the potential time-varying associations between HbA and mortality, as well as the terminal trajectory of HbA in the elderly to reveal the underlying mechanisms.
The design is a longitudinal study using data from the Health and Retirement Study.
Data were from the Health and Retirement Study. A total of 10,408 participants aged ≥50 years with available HbA measurements at baseline (2006/2008) were included.
Longitudinal HbA measured at 2010/2012 and 2014/2016 were collected. HbA values measured three times for their associations with all-cause mortality were assessed using Cox regression and restricted cubic splines. HbA terminal trajectories over 10 years before death were analyzed using linear mixed-effect models with a backward time scale.
Women constitute 59.6% of the participants with a mean age of 69 years, with 3,070 decedents during the follow-up (8.9 years). The mortality rate during follow-up was 29.5%. Increased mortality risk became insignificant for the highest quartile of HbA compared to the third quartile (aHR 1.148, 1.302, and 1.069 for a follow-up of 8.9, 6.5, and 3.2 years, respectively) with a shorter follow-up, while it became higher for the lowest quartile of HbA (aHR 0.986, 1.068, and 1.439 for a follow-up of 8.9, 6.5, and 3.2 years, respectively). Accordingly, for both decedents with and without diabetes, an initial increase in HbA was followed by an accelerating terminal decline starting 5-6 years before death.
The time-varying association between HbA and mortality mapped to the terminal trajectory in HbA. High and low HbA may have different clinical relationships with mortality. The HbA paradox may be partially explained by reverse causation, namely, early manifestation of death.
评估 HbA 与死亡率之间潜在的时变关联，以及老年人 HbA 的终末轨迹，以揭示潜在机制。
本研究采用来自健康与退休研究的数据进行纵向研究。
数据来自健康与退休研究。共有 10408 名年龄≥50 岁且在基线（2006/2008 年）时有 HbA 测量值的参与者被纳入研究。
收集 2010/2012 年和 2014/2016 年的纵向 HbA 测量值。使用 Cox 回归和限制性立方样条评估三次测量的 HbA 与全因死亡率的相关性。使用带有反向时间尺度的线性混合效应模型分析死亡前 10 年的 HbA 终末轨迹。
参与者中女性占 59.6%，平均年龄为 69 岁，随访期间（8.9 年）有 3070 名死亡者。随访期间的死亡率为 29.5%。与第三四分位相比，HbA 最高四分位的死亡风险增加不再具有统计学意义（随访 8.9、6.5 和 3.2 年时的校正危险比[aHR]分别为 1.148、1.302 和 1.069），随访时间越短，这种情况越明显，而 HbA 最低四分位的死亡风险更高（随访 8.9、6.5 和 3.2 年时的 aHR 分别为 0.986、1.068 和 1.439）。相应地，对于有和没有糖尿病的死亡者，HbA 最初升高后，在死亡前 5-6 年开始出现加速的终末下降。
HbA 与死亡率之间的时变关联与 HbA 的终末轨迹相对应。高和低 HbA 可能与死亡率存在不同的临床关系。HbA 悖论可能部分归因于反向因果关系，即死亡的早期表现。
