Younger adults with prediabetes face a higher risk of death compared with their peers without the condition, according to a recent research letter.

A cohort study was conducted to examine whether demographic, lifestyle, and comorbidity factors modify the association between prediabetes and mortality in US adults. The investigators analyzed data from the National Health and Nutrition Examination Survey linked to the National Death Index for survey cycles from 1999 through 2018.

Of 38,093 respondents, 9,971 (26.2%), representing an estimated 51 million US adults, had prediabetes. The majority of respondents were female and aged 20 to 54 years. In unadjusted analyses, prediabetes was associated with increased mortality risk (hazard ratio [HR], 1.58). Adjustment for demographics reduced the association (HR, 0.88), and further adjustment for lifestyle factors (HR, 0.92) and comorbidities (HR, 1.05) rendered it nonsignificant.

Stratified analyses showed an association between prediabetes and mortality only among adults aged 20 to 54 years (HR, 1.68). No significant associations were observed in adults aged 55 to 74 years (HR, 0.87) or aged 75 years or older (HR, 0.97), nor within any racial or ethnic subgroup.

Adults aged 20 years or older who completed both interviews and physical examinations had valid mortality data and met inclusion criteria were eligible. Prediabetes was defined as self-reported history or hemoglobin A1c levels between 5.7% and 6.4%. Covariates included demographic characteristics, lifestyle behaviors such as smoking and alcohol use, and comorbidities including hypertension, heart disease, stroke, and cancer. Multivariable Cox proportional hazards models were used to estimate HRs for mortality, with sequential adjustments: demographics alone, demographics plus lifestyle, and demographics plus lifestyle and comorbidities. Analyses were stratified by age group and race and ethnicity.

Obinna Ekwunife, PhD, reported receiving grants from the National Institutes of Health during the conduct of the study; no other disclosures were reported.

Source: JAMA Network Open