What question did this study set out to answer?

This study investigates how the neutrophil-to-high-density lipoprotein cholesterol ratio and monocyte-to-high-density lipoprotein cholesterol ratio are associated with chronic obstructive pulmonary disease prevalence.

April 14, 2026Open Access

Association between inflammatory biomarkers based on high-density lipoprotein cholesterol and chronic obstructive pulmonary disease: a cross-sectional study

Key Points

This study investigates how the neutrophil-to-high-density lipoprotein cholesterol ratio and monocyte-to-high-density lipoprotein cholesterol ratio are associated with chronic obstructive pulmonary disease prevalence.
Utilized NHANES data from 1999 to 2020
Calculated NHR and MHR using standardized methods
Defined COPD based on questionnaires
Employed weighted logistic regression to evaluate associations
Conducted sensitivity and subgroup analyses to assess robustness
Each 1-unit increase in NHR linked to 5.9% higher odds of COPD (OR = 1.059)
Each 1-unit increase in MHR linked to 65.2% higher odds of COPD (OR = 1.652)
Nonlinear associations observed with stronger links below specific inflection points for NHR and MHR
Significant effect modification found with hypertension for NHR and smoking for MHR
Sensitivity analyses supported primary findings

Abstract

The purpose of this study is to investigate the associations of the neutrophil-to-high-density lipoprotein cholesterol ratio (NHR) and monocyte-to-high-density lipoprotein cholesterol ratio (MHR) with the prevalence of chronic obstructive pulmonary disease (COPD). This study utilized National Health and Nutrition Examination Survey (NHANES) data from 1999 to 2020, calculated NHR and MHR using standardized methods, and COPD was defined based on questionnaires. Weighted logistic regression was employed to evaluate the associations between NHR, MHR, and COPD, while restricted cubic spline (RCS) analysis was used to explore potential nonlinear associations. Additionally, stratified and interaction analyses were conducted to assess the consistency of these associations. Sensitivity analyses using a more stringent, multi-criteria COPD definition incorporating spirometry and medication information were also conducted to evaluate the robustness of the findings. A total of 30,292 participants were enrolled, including 2,400 individuals with COPD. Results from multivariable logistic regression analyses showed that each 1-unit increase in NHR and MHR was associated with 5.9% (OR = 1.059, 95% CI: 1.026–1.093, P = 0.0006) and 65.2% (OR = 1.652, 95% CI: 1.262–2.161, P = 0.0004) higher odds of COPD, respectively. RCS analyses showed nonlinear associations, with stronger associations below the inflection points of NHR (4.781) and MHR (0.729) and saturation thereafter. Subgroup analyses demonstrated significant effect modification in the associations of NHR and MHR with COPD prevalence. NHR showed a significant interaction with hypertension status (P for interaction < 0.001), whereas MHR exhibited significant interactions with smoking status and hypertension (P for interaction < 0.05). Sensitivity analyses yielded results consistent with the primary findings. NHR and MHR were significantly and nonlinearly associated with prevalent COPD among U.S. adults. As this study relies on NHANES data without external validation, future prospective studies with validation in independent populations are needed to confirm these findings.

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