Association between platelet/high-density lipoprotein cholesterol ratio and asthma in American adults: A population-based study

Background: Asthma is a chronic inflammatory disease in adults, in which systemic inflammation plays a key pathogenic role. The platelet-to-high-density lipoprotein ratio (PHR) has emerged as a biomarker of systemic inflammation. Although studied in relation to asthma, its association with adult asthma remains inadequately characterized, and evidence from large-scale epidemiological studies is limited. Objective: This study aimed to investigate the association between the PHR and asthma in adults, using data from the National Health and Nutrition Examination Survey (NHANES) 2011–2018. Methods: A cross-sectional analysis was performed on 22,617 adult participants from NHANES. Asthma status was defined based on self-report, and PHR was calculated as platelet count (1,000/μL) divided by high-density lipoprotein cholesterol (mg/dL). We used multivariable logistic regression to examine the association between PHR (analyzed as both continuous and categorical variables by quartiles) and asthma. Nonlinearity was assessed using restricted cubic splines, and the robustness of findings was evaluated through a series of sensitivity analyses, including weighted regression and multiple imputation for missing data. Results: Using multivariable logistic regression, we found a significant positive association between PHR and adult asthma (OR = 1.03, 95% CI: 1.01–1.05; P = 0.009). When PHR was divided into quartiles, the Q2 and Q4 groups had higher asthma risk than Q1 (risk ratios of 1.19 and 1.20, respectively). Asthma prevalence increased significantly across PHR quartiles ( P for trend <0.001). Restricted cubic spline analysis indicated a linear relationship, with the odds of asthma rising as PHR increased. These results remained robust in both weighted and sensitivity analyses. Conclusions: Our findings show that higher PHR is associated with an increased prevalence of asthma, suggesting that higher PHR may be linked to asthma diagnosis in US adults.