Association Between C-Reactive Protein-to-Lymphocyte Ratio and Stroke Prevalence: A Cross-Sectional Analysis of NHANES 2015–2023

Abstract Background Stroke is a leading cause of mortality and disability, with chronic inflammation playing a key role in its pathogenesis. The C-reactive protein-to-lymphocyte ratio (CLR) is a novel index reflecting systemic inflammation (CRP) and immune status (lymphocyte count). However, the association between CLR and stroke in the general population is limited. This study aimed to examine the relationship between CLR and stroke prevalence in a nationally representative U.S. sample. Methods Data from the 2015–2023 National Health and Nutrition Examination Survey (NHANES) were used. Participants with complete data on stroke status, demographics, clinical covariates, and laboratory measures of CRP and lymphocyte count were included.Multiple logistic regression models assessed the relationship between CLR and self-reported stroke, adjusting for age, sex, race/ethnicity, socioeconomic status, lifestyle factors, and cardio metabolic risk factors. Subgroup analyses explored interactions by age, sex, hypertension, and diabetes. Results Among 13,364 participants, 557 reported a history of stroke. In the fully adjusted model, participants in the highest CLR quartile (≥ 2.15) had a 43% higher odds of stroke (OR = 1.43; 95% CI, 1.08–1.89; p = 0.013) compared to those in the lowest quartile (< 0.41). Restricted cubic spline analyses suggested a nonlinear relationship, with elevated stroke risk at higher CLR levels. Conclusions Higher CLR is significantly associated with increased stroke prevalence in the U.S. adult population, independent of traditional risk factors. Prospective studies are needed to confirm the temporal and causal nature of this association and explore the potential role of CLR in stroke risk stratification and prevention.