Nine anthropometric insulin resistance indices predict mortality and life expectancy across glucose states.

We compared the impact of insulin resistance indicators (triglyceride-glucose index, TyG) combined with different obesity metrics on long-term survival rates across varying states of glucose metabolism. In 11,787 U.S. adults aged ≥45 years from NHANES (1999-2018; mortality follow-up through December 31, 2019) and 12,915 participants from CHARLS for external validation, we examined nine TyG-derived indices using glycemic-status-stratified Cox models and flexible dose-response analyses, and assessed their predictive utility and clinical net benefit. The TyG index combined with a body shape index (TyG-ABSI) showed relatively consistent associations with all-cause and cardiovascular mortality and comparatively favorable incremental predictive performance; external validation in CHARLS supported its association with all-cause mortality, although its standalone discriminatory ability was modest. Higher TyG-ABSI was also associated with shorter life expectancy and a larger estimated population-attributable fraction, supporting its potential role in risk stratification across glucose metabolism states.