Uric acid-to-HDL cholesterol ratio is independently associated with prediabetes in a large multinational primary care population in Qatar: a cross-sectional study

Prediabetes is frequently underdiagnosed and carries significant cardiometabolic risk. The uric acid-to-high-density lipoprotein cholesterol ratio (UHR) has emerged as a marker of metabolic dysfunction, but its association with prediabetes in large multinational primary care populations remains poorly characterized. This study aimed to assess this association, compare UHR with its individual components, and evaluate effect modification and discriminatory performance. This retrospective cross-sectional study used anonymized electronic medical records from Primary Health Care Corporation, Qatar, between July 2021 and June 2025. Adults aged 18–60 years with available uric acid, HDL-C, and glycaemic data were included. Prediabetes was defined using American Diabetes Association glycaemic thresholds based on available fasting plasma glucose or HbA1c. Multivariable logistic regression adjusted for age, sex, BMI, and nationality-derived geographic sub-region. Interaction, sensitivity, and receiver operating characteristic analyses were performed. Among 113,795 participants, 30,125 (26.5%) had prediabetes. Median UHR was higher in participants with prediabetes than controls (0.120 vs. 0.100; P < 0.001). Each 0.01-unit higher UHR was associated with higher adjusted odds of prediabetes (aOR 1.057, 95% CI 1.053–1.062), with a graded association across quartiles (Q4 vs. Q1: aOR 2.300, 95% CI 2.167–2.440). The association remained similar in missing-BMI sensitivity analyses and was stronger in women (interaction P < 0.001), with no evidence of interaction by geographic sub-region ( P = 0.125). UHR showed modest discrimination (AUC 0.618), with an exploratory threshold of approximately 0.106. UHR was independently associated with prediabetes across a large multinational primary care population. However, discrimination was modest and the exploratory threshold requires external prospective validation before any clinical implementation. Not applicable.