title: Race-ethnicity as an effect modifier of the association between HbAlc and mortality in U.S. adults without diagnosed diabetes.
abstract: OBJECTIVE
  HbAlc is increasingly appreciated as a risk factor for all-cause and cardiovascular disease (CVD) mortality in the non-diabetic population. In this study, we investigated the association between HbAlc and mortality with a particular focus on the impact of race-ethnicity. Design Cohort study.
  
  
  METHODS
  We analyzed the association between HbAlc and all-cause and CVD mortality in 12 698 non-diabetic adults 20 years or older from the Third National Health and Nutrition Examination Survey using separate models for people of different race-ethnicity.
  
  
  RESULTS
  In our stratified analyses, higher non-diabetic HbAlc levels were associated with all-cause and CVD mortality in non-Hispanic whites only. In this group, compared with HbAlc values of 5.0-<5.35%, the multivariable-adjusted estimated hazard ratios (est. HR) with 95% confidence interval (CI) for all-cause mortality were 1.21 (0.92, 1.58), 1.22 (1.03, 1.45), 1.29 (1.14, 1.47), and 1.4 (1.02, 1.87) for HbAlc levels of <5.0, 5.35-<5.7, 5.7-<6.5, and 6.5% or greater respectively. The association did not reach significance in Mexican-Americans (est. HR (95% CI): 1.77 (1.08, 2.91), 0.81 (0.56, 1.19), 1.16 (0.86, 1.57), and 1.4 (0.83, 2.36)). No association was observed in non-Hispanic blacks: 1.13 (0.91, 1.39), 0.81 (0.61, 1.08), 0.84 (0.69, 1.03), and 0.94 (0.67, 1.33). Results were similar for CVD mortality.
  
  
  CONCLUSIONS
  Our data suggest limitations of HbAlc as a risk factor for all-cause and cardiovascular mortality across race-ethnic populations.
authors.affiliation: Department of Epidemiology, College of Public Health, University of Kentucky, Suite 213, 121 Washington Avenue, Lexington, Kentucky 40536-0003, USA.
authors.forename: Katharina G
authors.initials: KG
authors.lastname: Kehl
authors.forename: Hannes M
authors.initials: HM
authors.lastname: Findeisen
authors.forename: David W
authors.initials: DW
authors.lastname: Fardo
authors.forename: Dennis
authors.initials: D
authors.lastname: Bruemmer
authors.forename: David M
authors.initials: DM
authors.lastname: Mannino
authors.forename: Wayne T
authors.initials: WT
authors.lastname: Sanderson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000097:blood / Q000453:epidemiology / Q000208:ethnology* / Q000401:mortality*; D002423:Cause of Death; D048909:Diabetes Complications / Q000175:diagnosis / Q000453:epidemiology / Q000208:ethnology / Q000401:mortality; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000208:ethnology; D015987:Effect Modifier, Epidemiologic; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis* / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D044469:Racial Groups / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human