Stress Hyperglycemia Ratio as a Predictor of All‐Cause and Cardiovascular Mortality in the General Population: Insights From NHANES 2001–2018

Background Stress hyperglycemia ratio (SHR) is closely related to adverse clinical outcomes. However, the link between general population all‐cause mortality (ACM) and cardiovascular mortality (CVM) remains undetermined. Thus, this research was designed to investigate the associations between SHR and ACM and CVM. Methods The research data are sourced from NHANES. The correlations between SHR and death were examined via multivariate Cox proportional hazards models. These models were adjusted for clinical, socioeconomic, and demographic characteristics. Potential nonlinear relationships were estimated via restricted cubic spline (RCS) analysis. Predictive accuracy was measured by time‐dependent ROC curves, and mortality risk across SHR quartiles was examined by Kaplan–Meier survival curves. Age, sex, race, BMI, level of education, smoke, and poverty‐income ratio were used as subgroups to investigate potential moderators of the effect. Results About 1847 people died from any cause and 589 from cardiovascular disease throughout the median follow‐up period of 97 months. SHR was negatively associated with ACM (HR: 0.77, 95% CI: 0.68–0.88) and CVM (HR: 0.73, 95% CI: 0.60–0.90) when SHR was below the threshold values (SHR < 0.81 in ACM and SHR< 0.84 in CVM), whereas it was positively associated with ACM (HR: 1.10, 95%CI: 1.05–1.15) and CVM (HR: 1.08, 95%CI: 1.00–1.16) when it was above the threshold values. The ROC curve revealed that the SHR may serve as a predictor of ACM and CVM. Conclusions SHR exhibits a nonlinear, threshold‐dependent association with ACM and CVM, and it may serve as a predictor of ACM and CVM.