Association between different insulin resistance surrogates and all-cause mortality in patients with Osteoarthritis: Evidence from a large population-based study

Background Timely identification and intervention of risk factors impacting prognosis are imperative for individuals with Osteoarthritis (OA). However, the relationship between insulin resistance (IR) surrogates and long-term all-cause mortality in patients with OA remains unclear. This study aimed to explore the relationship between different IR surrogates and all-cause mortality and identify valuable predictors of survival status in this population. Methods The data came from the National Health and Nutrition Examination Survey (NHANES 2001–2018) and National Death Index (NDI). Multivariate Cox regression and restricted cubic splines (RCS) were performed to evaluate the relationship between homeostatic model assessment of IR (HOMA-IR), triglyceride glucose index (TyG index), triglyceride glucose-body mass index (TyG-BMI index) and all-cause mortality. The segmented regression and Log-likelihood ratio test were conducted to calculate cut-off points when segmenting effects were found. Then, segmented Kaplan–Meier analysis, LogRank tests, and multivariable Cox regression were carried out. Receiver operating characteristic (ROC) and decision curve analysis (DCA) were drawn to evaluate the differentiation and accuracy of IR surrogates in predicting the all-cause mortality. Stratified analysis and interaction tests were conducted according to age, gender, diabetes, cancer, and hypoglycemic drugs or insulin use. Results 1154 participants were included in the study. During the median follow-up of 124 months, 369 participants died. RCS showed that HOMA-IR had a segmented effect on all-cause mortality. 3.72 was a statistically significant inflection point. When the HOMA-IR was less than 3.72, it was negatively associated with all-cause mortality[HR = 0.78,95%CI (0.64, 0.94),P = 0.011]. Conversely, when the HOMA-IR was greater than 3.72, it was positively associated with all-cause mortality [HR = 1.05,95%CI (1.01, 1.09),P = 0.017]. ROC and calibration curves indicated that HOMA-IR was a reliable predictor of survival status (area under curve = 0.8475). No interactions between HOMA-IR and stratified variables were found. Conclusion HOMA-IR display a U-shaped association with all-cause mortality in patients with OA. HOMA-IR was a reliable predictor of all-cause mortality in this population.