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A New Zealand linkage study examining the associations between glycosylated haemoglobin concentration and mortality

¹Centre for Public Health Research, Massey University, New Zealand
²Public Health Intelligence, Health and Disability Systems Strategy, Ministry of Health, New Zealand
³Research Centre for Mori Health and Development, Massey University, New Zealand
⁴Hepatitis Foundation of New Zealand

N.Brewer{at}massey.ac.nz

ABSTRACT

Objective: To examine associations between glycosylated haemoglobin (HbA_1c) concentration and mortality in a New Zealand population.

Research Design and Methods: During a Hepatitis Foundation screening campaign for hepatitis B (1999 to 2001), participants were offered HbA_1c testing. The participants were anonymously linked to the national mortality collection to 31^st December 2004. Hazard ratios (HRs) and 95% confidence intervals (95%CI) adjusted for age, ethnicity, smoking and gender were estimated using Cox regression.

Results: There were 47,904 participants (71% Mori, 12% Pacific, 5% Asian, 12% Other). HbA_1c measurements were categorised as: <4.0% (n=142); 4.0–<5.0% (reference category; n=12,867); 5.0–<6.0% (n=30,222); 6.0–<7.0% (n=2,669); 7.0% (n=1,596); there were also 408 participants with a previous diabetes diagnosis. During the follow-up period, 815 individuals died. In those without a prior diabetes diagnosis, there were steadily increasing HRs from the HbA_1c reference category to the highest category (7.0%; HR 2.36, 95%CI 1.72–3.25). As well as all cause mortality, HbA_1c was associated with mortality from diseases of the circulatory system, endocrine, nutritional and metabolic and immunity disorders, and ‘other and unknown causes'. Mortality was also elevated in those with a prior diabetes diagnosis (HR 5.19, 95%CI 3.67–7.35), but this was only partially explained by their elevated HbA_1c levels.

Conclusions: This is the largest study to date of HbA_1c levels and subsequent mortality risk. It confirms previous findings that HbA_1c levels are strongly associated with subsequent mortality in both men and women without a prior diabetes diagnosis.

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