Abstract

Background:
Telomere length, a biomarker of cellular aging, has been associated with chronic disease risk and premature mortality. However, population-level data examining its relationship with sociodemographic and health indicators in the United States remain limited. This study investigates the associations between telomere length and key factors including age, gender, race/ethnicity, poverty-income ratio (PIR), body mass index (BMI), smoking status, diabetes status, and thyroxine (T4) levels.

Methods:
We conducted a cross-sectional analysis using weighted data from the 2021–2023 cycle of the National Health and Nutrition Examination Survey (NHANES). Telomere length was categorized into short, intermediate, and long tertiles. Chi-square tests and Rao-Scott adjusted statistics were used for bivariate associations. Cumulative logistic regression models were employed to assess multivariable-adjusted relationships between telomere length and explanatory variables, controlling for the complex survey design.

Results:
A total of 4,450 adults were included. Telomere length was significantly associated with age (p < 0.0001), diabetes status (p < 0.0001), smoking status (p = 0.0144), and BMI category (p = 0.0239). Participants aged 30–49 were significantly more likely to have longer telomeres than those aged 65+ (aOR = 5.08; 95% CI: 3.86–6.67). No significant association was observed between telomere length and race/ethnicity or T4 levels. In fully adjusted models, prediabetes was marginally associated with shorter telomere length (aOR = 0.83; 95% CI: 0.66–1.03; p = 0.0886).

Conclusion:
Telomere length is strongly associated with age and modestly linked to metabolic and behavioral risk factors such as diabetes, BMI, and smoking. These findings reinforce the utility of telomere length as a biological aging marker and highlight the need for targeted interventions addressing modifiable risk factors among younger adults.