Abstract
Background
The cardiometabolic index (CMI), a composite marker derived from the product of waist-to-height ratio and triglyceride-to- high-density lipoprotein cholesterol ratio, has emerged as a potential indicator of metabolic risk. However, the prognostic value of the CMI across diverse populations and the continuum from cardiometabolic disease prevalence to mortality remains poorly characterised.Method
This study integrated data from two nationally representative datasets: 17,922 adults from the US National Health and Nutrition Examination Survey (NHANES; 1999-2018; longitudinal) and 9,313 adults from the China Health and Retirement Longitudinal Study (CHARLS; 2011; cross-sectional). Multivariate Cox regression models estimated hazard ratios (HRs) for mortality, whereas logistic regression models estimated odds ratios (ORs) for disease prevalence. Restricted cubic splines (RCSs) were used to evaluate dose-response relationships.Results
In the NHANES cohort, elevated CMI was significantly associated with increased risks of all-cause mortality (HR 1.35; 95% confidence interval [CI] 1.26-1.44), cardiovascular disease (CVD) mortality (HR 1.30; 95% CI 1.17-1.45), and diabetes mortality (HR 1.91; 95% CI 1.56-2.34). Age significantly modified these associations (p for interaction Conclusions
CMI is a robust, low-cost indicator for predicting mortality in US adults and cardiometabolic disease burden in Chinese adults. Its greater predictive utility in younger populations supports its clinical implementation for early-onset risk stratification and targeted prevention globally.