Sex-Specific Associations of Iron-Anemia Status With Hemoglobin A1C Levels Among Hispanics/Latinos Without Self-Reported Diabetes Mellitus: The Hispanic Community Health Study/Study of Latinos

Objective: The objective of this study was to examine the sex-specific associations of mutually exclusive iron-anemia status categories with hemoglobin A1C (HbA1C) levels among U.S. Hispanics/Latinos without self-reported diabetes mellitus. Methods: Baseline cross-sectional data (7247 women and 4904 men without self-reported diabetes mellitus) from the Hispanic Community Health Study/Study of Latinos were analyzed. Per the American Diabetes Association's defined criteria, based on HbA1C levels, the participants were categorized as having normoglycemia, prediabetes, or probable diabetes mellitus. The iron-anemia status categories were as follows: no anemia and no iron deficiency (reference), iron deficiency, iron deficiency anemia (IDA), and non-iron deficiency anemia (non-IDA). Survey multinomial logistic regression models were used to examine the sex-specific associations of iron-anemia status with HbA1C levels after adjusting for sociodemographic, lifestyle, and clinical factors. Results: The age-standardized prevalence of iron-anemia status categories differed by sex. Compared with those with no anemia and no iron deficiency and normoglycemia, women with IDA had higher odds of having prediabetes (odds ratio [OR], 2.18; 95% CI, 1.64-2.89) and probable diabetes mellitus (OR, 3.59; 95% CI, 1.62-7.99) based on HbA1C levels; men with non-IDA had higher odds of having probable diabetes mellitus (OR, 2.97; 95% CI, 1.13-7.78) based on HbA1C levels. All other associations did not reach statistical significance. Conclusion: Among U.S. Hispanics/Latinos without self-reported diabetes mellitus, the age-standardized prevalence of iron deficiency, IDA, and non-IDA is high and varies by sex. Women with IDA had higher odds of having prediabetes and probable diabetes mellitus, defined based on HbA1C levels. Men with non-IDA had higher odds of having probable diabetes mellitus, defined based on HbA1C levels. Iron-anemia status should be considered while interpreting elevated HbA1C levels among U.S. Hispanics/Latinos without self-reported diabetes mellitus.