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

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. 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. 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. 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.