Association between platelet-to-high-density lipoprotein cholesterol ratio and incident diabetes risk: a national representative cohort study based on CHARLS
- 1Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, P.R. China
- 2Department of Pediatrics, Chengdu Second People’s Hospital, Chengdu, Sichuan Province P.R. China
- 3Department of Pediatrics, West China Second University Hospital of Sichuan University, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth, Defects of Ministry of Sichuan University, Chengdu, Sichuan province P.R. China
Abstract
Background: Diabetes mellitus has become a major global public health burden, particularly in China. The platelet-to-high-density lipoprotein cholesterol ratio (PHR) has emerged as a novel inflammatory and metabolic biomarker associated with cardiometabolic risk. However, prospective evidence regarding its association with incident diabetes remains limited. This study aimed to investigate the association between PHR and the risk of incident diabetes among Chinese middle-aged and older adults.
Methods: This prospective cohort study used data from the China Health and Retirement Longitudinal Study (CHARLS) spanning from 2011 to 2020. A total of 5835 participants without diabetes at baseline (2011–2012) were included and followed up in 2013, 2015, 2018, and 2020. Participants were divided into four groups according to PHR quartiles. Kaplan-Meier survival analysis and Cox proportional hazards regression models were employed to evaluate the association between PHR and incident diabetes. Restricted cubic spline (RCS) regression was performed to explore potential linear and non-linear relationships. Subgroup and sensitivity analyses were conducted to assess the robustness of the findings.
Results: During a median follow-up of 116 months, 669 participants developed incident diabetes. Kaplan–Meier analysis revealed a significantly higher cumulative incidence of diabetes in higher PHR quartiles (log-rank p < 0.001). After multivariable adjustment, Cox regression showed that participants in the highest PHR quartile (Q4) had a significantly increased risk of diabetes compared with those in the lowest quartile (Q1) (adjusted hazard ratio (HR) = 1.41, 95% confidence interval (CI): 1.11–1.78, p = 0.004). RCS analysis indicated a positive linear relationship between PHR and diabetes risk (P for nonlinearity = 0.339). Subgroup analyses showed that the association was generally consistent across most subgroups. Sensitivity analyses, including use of a composite diabetes definition (Q4 vs Q1: HR = 1.30, 95% CI: 1.09–1.56) and multiple imputation, yielded consistent findings.
Conclusions: Elevated PHR levels were associated with an increased risk of incident diabetes among Chinese middle-aged and older adults. Component-specific analyses suggested that this association may be driven predominantly by HDL-C. PHR may represent a simple and routinely available candidate biomarker associated with incident diabetes risk; however, whether it provides information beyond HDL-C alone requires further investigation.
Clinical trial registration: Not applicable.
Supplementary information: The online version contains supplementary material available at https://doi.org/10.1186/s12902-026-02627-x.
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BibTeX
@article{chen2026association,
title = {{Association between platelet-to-high-density lipoprotein cholesterol ratio and incident diabetes risk: a national representative cohort study based on CHARLS}},
author = {Lizhu Chen and Chengpeng He and Xiaolu Chen},
journal = {BMC Endocrine Disorders},
year = {2026},
month = oct,
doi = {10.1186/s12902-026-02627-x},
url = {https://doi.org/10.1186/s12902-026-02627-x},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Association between platelet-to-high-density lipoprotein cholesterol ratio and incident diabetes risk: a national representative cohort study based on CHARLS
AU - Lizhu Chen
AU - Chengpeng He
AU - Xiaolu Chen
PY - 2026
DA - 2026/10/12
JO - BMC Endocrine Disorders
DO - 10.1186/s12902-026-02627-x
UR - https://doi.org/10.1186/s12902-026-02627-x
AB - Background: Diabetes mellitus has become a major global public health burden, particularly in China. The platelet-to-high-density lipoprotein cholesterol ratio (PHR) has emerged as a novel inflammatory and metabolic biomarker associated with cardiometabolic risk. However, prospective evidence regarding its association with incident diabetes remains limited. This study aimed to investigate the association between PHR and the risk of incident diabetes among Chinese middle-aged and older adults. Methods: This prospective cohort study used data from the China Health and Retirement Longitudinal Study (CHARLS) spanning from 2011 to 2020. A total of 5835 participants without diabetes at baseline (2011–2012) were included and followed up in 2013, 2015, 2018, and 2020. Participants were divided into four groups according to PHR quartiles. Kaplan-Meier survival analysis and Cox proportional hazards regression models were employed to evaluate the association between PHR and incident diabetes. Restricted cubic spline (RCS) regression was performed to explore potential linear and non-linear relationships. Subgroup and sensitivity analyses were conducted to assess the robustness of the findings. Results: During a median follow-up of 116 months, 669 participants developed incident diabetes. Kaplan–Meier analysis revealed a significantly higher cumulative incidence of diabetes in higher PHR quartiles (log-rank p < 0.001). After multivariable adjustment, Cox regression showed that participants in the highest PHR quartile (Q4) had a significantly increased risk of diabetes compared with those in the lowest quartile (Q1) (adjusted hazard ratio (HR) = 1.41, 95% confidence interval (CI): 1.11–1.78, p = 0.004). RCS analysis indicated a positive linear relationship between PHR and diabetes risk (P for nonlinearity = 0.339). Subgroup analyses showed that the association was generally consistent across most subgroups. Sensitivity analyses, including use of a composite diabetes definition (Q4 vs Q1: HR = 1.30, 95% CI: 1.09–1.56) and multiple imputation, yielded consistent findings. Conclusions: Elevated PHR levels were associated with an increased risk of incident diabetes among Chinese middle-aged and older adults. Component-specific analyses suggested that this association may be driven predominantly by HDL-C. PHR may represent a simple and routinely available candidate biomarker associated with incident diabetes risk; however, whether it provides information beyond HDL-C alone requires further investigation. Clinical trial registration: Not applicable. Supplementary information: The online version contains supplementary material available at https://doi.org/10.1186/s12902-026-02627-x.
SN - 1472-6823
ER -