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Evidence of non‐linearity in the association of glycemic control with influenza/pneumonia mortality: a study of 19 000 adults from the US general population
Author(s) -
Breitling Lutz P.
Publication year - 2016
Publication title -
diabetes/metabolism research and reviews
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.307
H-Index - 110
eISSN - 1520-7560
pISSN - 1520-7552
DOI - 10.1002/dmrr.2681
Subject(s) - medicine , diabetes mellitus , epidemiology , observational study , population , glycemic , pneumonia , public health , environmental health , intensive care medicine , demography , gerontology , pathology , endocrinology , sociology
Background Diabetes is a major public health problem and thought to be a risk factor for infectious diseases, but pertinent epidemiological evidence is limited. This study aimed to analyse the associations of diabetes, disease duration and glycated haemoglobin levels (HbA1c) with infectious diseases mortality in the general population, including the investigation of potential non‐linear relationships. Methods An observational, prospective study of 19 783 subjects included in the Third National Health and Nutrition Examination Survey, representing the adult non‐institutionalized population of the United States of America, was conducted. The analysis was done by multiple Cox regression and restricted cubic spline modelling. Results Self‐reported diabetes and diabetes duration were not significantly associated with the outcomes. However, there was evidence for a non‐linear association of HbA 1c with mortality from influenza, pneumonia or other acute lower respiratory infections. Spline regression suggested a roughly doubled risk of mortality beyond an HbA 1c of 6.5% (48 mmol/mol) in reference to 5.2% (33 mmol/mol). Conclusions Future studies on diabetes and infections should adequately address potential non‐linearity, which may be necessary to better understand and characterize more precisely the relationship of diabetes with infectious diseases. Copyright © 2015 John Wiley & Sons, Ltd.