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. 2025 Jul 1;15(1):21529.
doi: 10.1038/s41598-025-05686-7.

Red blood cell distribution width to albumin ratio is associated with osteoarthritis prevalence among US adults with diabetes using data from NHANES 2005 to 2018

Wang Lei #  1 , Guo Mixue #  2 , Dong Huqiang  3 , Li Zihua  2 , Tang Jing  2 , Zhao Wei  4 , Wang Guanghui  5
Affiliations

Red blood cell distribution width to albumin ratio is associated with osteoarthritis prevalence among US adults with diabetes using data from NHANES 2005 to 2018

Wang Lei et al. Sci Rep. .

Abstract

The aim of this study was to assess the relationship between red cell distribution width and albumin ratio (RAR) inflammatory markers and prevalence of osteoarthritis in a diabetic population by analyzing data from the National Health and Nutrition Examination Survey (NHANES). Using data from 2005 to 2018, using multivariate logistic regression, generalized additive models, and smooth curve fitting, we investigated the connection between RAR and osteoarthritis in diabetic individuals. Robustness checks included subgroup analyses. A total of 2698 participants were included in this study, in which the prevalence of osteoarthritis was 24.20%. After controlling for variables, multivariate logistic regression analysis revealed a significant and positive correlation between RAR levels and the prevalence of osteoarthritis (OR = 1.52, 95% CI: 1.24, 1.88). Smoothing curve analysis showed a significant nonlinear relationship between RAR levels and the prevalence of osteoarthritis (log likelihood ratio test P < 0.05). Threshold effect analysis showed an inflection point of 3.69 for RAR, and to the left of the inflection point, the OR for prevalence of osteoarthritis was 2.61 (95% CI: 1.77, 3.83) for each unit increase in RAR; interaction analyses showed that the variables did not have a significant effect on this relationship (p > 0.05 for all interactions). Elevated RAR is associated with an increased prevalence of osteoarthritis in diabetic patients. This study supports the hypothesis of an association between RAR and osteoarthritis in the U.S. diabetic population, and diabetic individuals with elevated RAR levels should be particularly aware of their increased risk of developing osteoarthritis.

Keywords: Cross-sectional study; NHANES; Osteoarthritis; RAR; Red blood cell distribution width to albumin ratio.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests. Conflict of interest: The authors declare no conflicts of interest. Ethical statement: The portions of this study involving human participants, human materials, or human data were conducted in accordance with the Declaration of Helsinki and were approved by the National Center for Health Statistics (NCHS) Ethics Review Board. The relevant protocol numbers were Protocol #2005-06 (approved in 2005), Protocol #2011-17 (approved in 2011 and continued in subsequent cycles), and Protocol #2018-01 (approved in 2018). The patients/participants provided their written informed consent to participate in the study. Detailed information about the ethical review and consent process is available on the NHANES website ( https://www.cdc.gov/nchs/nhanes/irba98.htm ).

Figures

Fig. 1
Fig. 1
NHANES 2005–2018 Participant Selection Flowchart.
Fig. 2
Fig. 2
RAR and OA smooth curve fitting.
Fig. 3
Fig. 3
Subgroup analysis of the association between RAR and OA.
See this image and copyright information in PMC

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