Association Between Fasting Plasma Glucose And All-Cause And Cause-Specific Mortality In Xinzheng Older Adults

ObjectivesWe aimed to explore the precise relationship between fasting blood glucose and all-cause mortality and cardiovascular disease mortality in older adults and to explore the combined effects of fasting blood glucose and other influencing factors on the mortality.MethodsThe cohort study was based on the database records for residents who entered the health check-up program for the elderly people aged 60 years and above,in Xinzheng City during 2011 to 2019,and we excluded participants with inclusion and exclusion criteria.The information of health check-up was collected by the questionnaires,physical measurements,laboratory detection and supplementary examination,death information was obtained through the death registration card.Student’s t-test,chi-square test,Mann-Whitney U test and Kendall’s tau-b analysis were used to compare the basic characteristics.Cox proportional hazards regression models and restricted cubic spline models were applied to assess the relationship between fasting blood glucose and all-cause mortality,cardiovascular disease mortality and cancer mortality.And further to explore the combined effects of fasting blood glucose with HTN,obesity and exercise on the mortality.ResultsA total of 67213 subjects(35537 women and 31676 men)were included in this study,with a cumulative follow-up of 356696 person-years(mean 5.96 years),9232deaths(death density: 259/10000 person-years)during follow-up,4927 cardiovascular disease(death density: 138/10000 person-years)and 1194 cancer deaths(death density: 33/1 0000 person-years).1.After adjusting for multiple confounding factors(age,sex,marital status,drinking,obesity,physical activity,HTN,cancer,stroke,COPD and mental illness),compared with the NFG(normal fasting glucose,NFG)group,the HR(95% CI)for LFG(light fasting glucose,LFG)group was 1.096(1.026-1.171),which in DM(diabetes mellitus,DM)group was 1.255(1.189-1.325).After adjusting for possible confounders,restricted cubic splines showed the fasting blood-glucose was associated with all-cause mortality,following a J-shaped curve.The plot showed a downward trend of the risk before 93mg/d L,which reached the lowest risk around93mg/d L and then increased there after(P for non-linearity<0.001).2.After adjusting for multiple confounding factors,compared with the NFG group,the HR(95% CI)for LFG group was 1.105(1.010-1.209),which in DM group was 1.249(1.160-1.344).After adjusting for possible confounders,restricted cubic splines showed the fasting blood-glucose was associated with cardiovascular disease mortality,following a J-shaped curve.The plot showed a lowest risk around93mg/d L and then increased there after(P for non-linearity<0.001).3.Cox proportional hazards regression models showed no association between fasting blood-glucose and cancer mortality in the general population,men and women(All P>0.05).4.Compared with NFG and without hypertension group,the HR(95% CI)for all-cause mortality was 1.198(1.117-1.286)in the DM and with hypertension group,which for cardiovascular disease mortality was 1.388(1.260-1.530).Compared with NFG and exercise group,the HR(95% CI)for all-cause mortality was 1.515(1.349-1.701)in the DM and never exercise group,which for cardiovascular disease mortality was 1.500(1.278-1.760).Conclusions1.The fasting blood-glucose was associated with all-cause mortality and cardiovascular disease mortality,following the J-shaped curve with a lowest risk around 93mg/d L,and there was no association between fasting blood-glucose and cancer mortality.2.The effect of diabetes mellitus on the risk of all-cause and cardiovascular death were strengthened by hypertension and never exercise.