Platelet-to-high-density lipoprotein ratio as a biomarker for asthma risk in adolescents: insights from NHANES 2011-2023.

Background: Asthma is a common inflammatory disease among adolescents, with systemic inflammation playing a key role in its development. The platelet-to-high-density lipoprotein ratio (PHR) has emerged as a novel indicator of systemic inflammation. However, while individual roles of platelet count and HDL cholesterol in asthma have been studied, the combined impact of PHR on asthma risk-particularly in adolescent populations-remains unclear and underexplored.

Objective: This study aimed to evaluate the association between PHR and asthma risk in adolescents using data from the National Health and Nutrition Examination Survey (NHANES) 2011-2023.

Methods: A cross-sectional analysis was conducted on 10,046 adolescents aged 8-18 years from NHANES. Asthma status was self-reported, and PHR was calculated as the ratio of platelet count (1,033 /μl) to HDL cholesterol (mg/dl). Logistic regression models were used to assess the association between PHR quartiles and asthma, adjusting for age, sex, race/ethnicity, body mass index (BMI), and poverty-to-income ratio (PIR). Restricted cubic spline (RCS) analysis was applied to examine non-linear relationships, with sensitivity and subgroup analyses conducted to ensure robustness.

Results: Adolescents with asthma had higher PHR levels compared to non-asthmatic peers (p < 0.001). In fully adjusted models, participants in the highest PHR quartile had significantly higher odds of asthma (OR = 1.59, 95% CI: 1.37-1.83, p < 0.001) compared to the lowest quartile. RCS analysis revealed a non-linear relationship, with asthma risk escalating sharply at higher PHR levels. Subgroup analyses confirmed consistent associations across race/ethnicity, BMI, and PIR categories. Sensitivity analyses excluding participants under 12 years of age yielded similar results.

Conclusion: PHR is significantly associated with asthma risk in adolescents, highlighting its potential as a cost-effective and accessible biomarker for identifying high-risk individuals. These findings underscore the need for further longitudinal and interventional studies to validate PHR's role in asthma prediction and management.