title: Relationship of hemoglobin A1c to mortality in nonsmoking insurance applicants.
abstract: OBJECTIVE
  Determine the relationship between hemoglobin A1c value and 5-year, all-cause mortality in nonsmoking life insurance applicants.
  
  
  METHODS
  By use of the Social Security Master Death Index, mortality was examined in 286,443 non-smoking insurance applicants aged 40 and up for whom blood samples for hemoglobin A1c were submitted to the Clinical Reference Laboratory. Results were stratified by hemoglobin A1c value, gender and age bands 40 to 59, 60 to 69 and 70 and up.
  
  
  RESULTS
  Increased mortality is apparent at hemoglobin A1c values of 6% and above, is linear, and on a percentage basis decreases with age. Hemoglobin A1c values less than 5% also are associated with increased mortality. Absolute mortality rates for females with elevated hemoglobin A1c are generally lower than rates for males, although mortality relative to the gender-specific reference group with hemoglobin A1c of 5% to 5.9% is generally the same for both.
  
  
  CONCLUSIONS
  The importance of even small elevations of hemoglobin A1c above 5.9% is apparent. For screening, it is the degree of blood sugar elevation as measured by hemoglobin A1c rather than any diagnostic label that is critical in risk assessment.
authors.affiliation: Address: Clinical Reference Laboratory, Jackson, CA, USA.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Stout
authors.forename: Michael
authors.initials: M
authors.lastname: Fulks
authors.forename: Vera F
authors.initials: VF
authors.lastname: Dolan
authors.forename: Mark E
authors.initials: ME
authors.lastname: Magee
authors.forename: Luis
authors.initials: L
authors.lastname: Suarez
mesh_terms: D000328:Adult; D000368:Aged; D002423:Cause of Death; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D007352:Insurance, Life; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D012907:Smoking; D014481:United States / Q000453:epidemiology
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human