Association between inflammatory burden index and cardiovascular and all-cause mortality in individuals living with diabetes and prediabetes: a NHANES cohort study.

Authors

Xiu Wu, Wei Cao

Published in

Integrative biology : quantitative biosciences from nano to macro. Volume 18. Jan 16, 2026.

Abstract

Diabetes mellitus (DM) and its cardiovascular complications represent one of the most prevalent causes of death worldwide, closely linked to chronic inflammatory states. Inflammatory Burden Index (IBI) is a composite inflammatory marker that comprehensively assesses systemic inflammation levels. Currently, the prognostic association of IBI with outcomes in individuals living with DM and prediabetes (pre-DM) remains unclear.
To investigate association of IBI with all-cause and cardiovascular mortalities in individuals living with DM and pre-DM.
Utilizing data from NHANES 1999-2010, we enrolled 8738 participants. Kaplan-Meier analysis and weighted multivariate Cox proportional hazards models were employed to examine relationship of IBI tertiles with mortality risk. RCS analysis tested for non-linear associations, while subgroup analyses evaluated effect modification. Sensitivity analysis was performed by excluding deaths occurring during the early follow-up period.
During a median 11.7 years of follow-up, 2726 all-cause deaths (31.2%) and 893 cardiovascular deaths (10.2%) were recorded. Results demonstrated significant associations of IBI with mortality risks in individuals living with pre-DM and DM. In fully adjusted model, compared with the lowest IBI tertile (T1), the highest tertile (T3) was associated with a 42% elevated risk of all-cause mortality (HR = 1.42, 95%CI: 1.24-1.63, P < 0.001) and a 38% elevated risk of cardiovascular mortality (HR = 1.38, 95%CI: 1.08-1.76, P = 0.011). RCS analysis revealed an overall significant association of IBI with mortality risks without evidence of non-linearity (P-non-linear>0.05). No significant interaction effects were seen in subgroup analyses. After excluding deaths occurring within the first 1 and 2 years of follow-up in sensitivity analyses, the above associations remained generally consistent.
Elevated IBI was significantly associated with elevated risks of all-cause and cardiovascular mortalities in persons with DM and pre-DM, suggesting that IBI may help identify subjects at higher mortality risk within this population.
Elevated inflammatory burden index was significantly associated with increased risks of all-cause and cardiovascular mortality in individuals with diabetes and prediabetes. Insight Box This study identifies the Inflammatory Burden Index as a stable, integrative biomarker linking systemic inflammation to elevated all-cause and cardiovascular mortality in prediabetic and diabetic individuals. By quantifying cumulative inflammatory burden rather than single markers, it provides a biologically coherent, clinically accessible tool for risk stratification. These findings support integrated inflammatory monitoring as a rational strategy to improve prognostic evaluation and targeted intervention in glucose metabolism disorders, bridging molecular inflammation, cardiometabolic pathophysiology, and population-level clinical outcomes.

PMID:
42855431
Bibliographic data and abstract were imported from PubMed on 10 Oct 2026.

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