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. 2025 May 22:16:1541294.
doi: 10.3389/fendo.2025.1541294. eCollection 2025.

Association of neutrophil to high-density lipoprotein cholesterol ratio with overactive bladder: a population-based study

Huifeng Zhang #  1 , Yaying Xu #  2 , Lele Chen  3
Affiliations

Association of neutrophil to high-density lipoprotein cholesterol ratio with overactive bladder: a population-based study

Huifeng Zhang et al. Front Endocrinol (Lausanne). .

Abstract

Background: Inflammation is involved in the progression of overactive bladder (OAB). This study aimed to investigate the association between the neutrophil to high-density lipoprotein cholesterol ratio (NHR) and OAB.

Methods: Data from seven cycles of the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018 were analyzed to examine the relationship between NHR and OAB. Multivariable logistic regression model was used to estimate the association between NHR and OAB, along with restricted cubic spline regression to assess the dose-response relationship. Additionally, subgroup analyses were conducted.

Results: Among 29,315 participants, 5,815 had OAB. After covariate adjustment, we found that NHR was positively associated with the odds of OAB. Notably, the relationship between NHR and OAB was nonlinear. There was a threshold at NHR = 2.85. When NHR < 2.85, no significant association was observed; when NHR ≥ 2.85, a positive association emerged. Subgroup and interaction analyses further revealed that the link between NHR and OAB was stronger in obese participants.

Conclusion: Our results indicate a nonlinear association between NHR and OAB. When NHR is ≥ 2.85, there is a strong positive association between NHR and the odds of OAB. The interaction between obesity and NHR further increases the prevalence of OAB. Prospective and multicenter studies are needed in the future to elucidate the potential mechanism underlying the association between NHR and OAB and determine the causal relationship.

Keywords: NHANES; cross-sectional study; inflammation; neutrophil to high-density lipoprotein cholesterol ratio; overactive bladder.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of participant selection.
Figure 2
Figure 2
Age-adjusted prevalence of OAB in diferent levels of NHR. Numbers at the top of the bars represent the weighted percentage. Bar whiskers represent the 95% confidence level. OAB, Overactive bladder; NHR, neutrophil to high-density lipoprotein cholesterol ratio.
Figure 3
Figure 3
Nonlinear analysis of the association between NHR and OAB. In the restricted cubic spline analysis, it was adjusted for sex, age, race, educational level, partner status, poverty income ratio, smoking, alcohol consumption, healthy diet, weekly exercise level, dietary health, body mass index, hypertension, cardiovascular disease, chronic kidney disease, liver disease, cancer, diabetes, hyperlipidemia, and lipid - lowering drugs. NHR, neutrophil to high-density lipoprotein cholesterol ratio; OAB, Overactive bladder.
Figure 4
Figure 4
Subgroup analysis and multiplication interaction tests of the association between NHR and OAB. In subgroup analysis, it was adjusted for sex, age, race, educational level, partner status, poverty income ratio, smoking, alcohol consumption, weekly exercise level, dietary health, body mass index, hypertension, cardiovascular disease, chronic kidney disease, liver disease, cancer, diabetes, hyperlipidemia, and lipid - lowering drugs. NHR, neutrophil to high-density lipoprotein cholesterol ratio; DM, diabetes; BMI, body mass index; Kg, kilogram; M2, square of meters; CVD, cardiovascular diseases; CKD, chronic kidney disease; OR, odds ratio; CI, confidence interval.
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