Sex differences in the association of UA/HDL-c ratio with mortality risk in the general population: An observational study from 1999 to 2018 NHANES data

Previous studies reported mixed results regarding the associations between uric acid or high-density lipoprotein cholesterol (HDL-c) and mortality risk. This study aimed to explore the associations between the novel indicator uric acid/HDL-c ratio (UHR) and all-cause or cardiovascular disease (CVD) mortality in the general population, as well as to examine sex disparities in this relationship. We included 27,659 adult participants from the 1999 to 2018 National Health and Nutrition Examination Survey. Kaplan-Meier survival curves, Cox proportional hazards regression models and restricted cubic spline analysis were applied for statistical analysis. During a median follow-up of 120 months, 2585 (727 CVD) deaths occurred. Restricted cubic spline analysis indicated a U-shaped association between UHR and all-cause or CVD mortality in the whole cohort, in men and in women, with inflection points at 10.8%, 12.18%, and 8.2%, respectively, for all-cause mortality, and 9.64%, 11.3%, and 9.79%, respectively, for CVD mortality. The associations between UHR and all-cause and CVD mortality were robust in both men and women in the sensitivity analyses. Associations between UHR and all-cause mortality were robust and nonlinear in the general population, with disparate inflection points for men and women.