The Association Between the Neutrophil-To-lymphocyte Ratio and Health-related Behaviors and Factors in Rural Adults With and Without Cardiometabolic Disease

Background Complete blood count (CBC) is a commonly used and cost-effective blood test in health screenings; however, its potential as a biomarker for early detection of chronic diseases remains underutilized. Previous studies have shown that the neutrophil-to-lymphocyte ratio (NLR) is associated with systemic inflammation and is correlated with cardiometabolic diseases (CMDs). Unhealthy lifestyles can trigger inflammatory responses and contribute to the progression of CMDs. This study aimed to explore the association between NLR levels, cardiometabolic risks, and health-related behaviors. Methods A community-based, cross-sectional study was conducted in collaboration with a local hospital as part of an annual health screening for rural adults. The study outcomes included CMDs, health-related behaviors, and NLR levels. A multivariable quantile regression model, adjusted for confounding factors, was used to identify factors associated with NLR levels. Results A total of 11,220 participants were enrolled. CMDs prevalence was 25.8%, with hypertension and diabetes being most common. Nearly half of participants reported insufficient exercise, low water intake, and inadequate oral hygiene. Higher NLR was significantly associated with CMDs ( p for trend <0.001). Older age ( p < .01) and living alone ( p < .01) were linked to higher NLR, while adequate water intake ( p < .05) and regular exercise ( p < .01) were associated with lower NLR levels. Conclusions Rural adults demonstrated a high prevalence of CMDs and inadequate health-related behaviors, which were associated with elevated NLR levels. Implementing NLR-guided lifestyle modifications and tailored health promotion programs may serve as innovative strategies to mitigate the progression of CMDs.