The linkage between hemoglobin-to-red blood cell distribution width ratio and osteoarthritis: a study based on the national health and nutrition examination survey

BACKGROUND: Inflammation is crucial in osteoarthritis (OA) pathogenesis. The hemoglobin-to-red cell distribution width ratio (HRR), an emerging inflammatory marker, remains unclear regarding its connection with OA. RESEARCH DESIGN AND METHODS: This study was based on National Health and Nutrition Examination Survey (NHANES) data spanning 2003-2016, covering 13,453 participants. Weighted logistic regression assessed the HRR-OA association. Subgroup and interaction analyses evaluated differences across populations. RESULTS: After adjusting for all confounders in the model, a negative association between HRR and OA (Odds Ratio (OR) = 0.56, 95% Confidence Interval (CI): 0.34-0.93) was detected. Compared to the lowest quartile, the third and highest HRR quartiles were associated with 23% (OR = 0.77) and 34% (OR = 0.66) lower OA odds, respectively. This inverse association was stronger in subgroups including individuals ≥65 years, males, and those widowed/divorced/separated. Marital status showed a significant interaction effect. CONCLUSIONS: HRR is negatively correlated with the risk of OA and may serve as a potential relevant biological marker. Future studies could further confirm the linkage between HRR and OA by integrating imaging assessments with clinical evaluations.