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Peer-reviewedCC BY-NC-NDBMC cancer

Hemoglobin-to-red blood cell distribution width ratio is inversely associated with prevalent gastrointestinal cancers in NHANES and serves as an informative feature in machine-learning models.

  • Shiming Chen1,2
  • Kexin Zhao3
  • Jingxia Zhang4
  • Yingxue Niu1,2
  • Ran Zou5
  • Min Wang6
  • Yifang Li7,8
8 affiliations
  1. 1College of Nursing, Anhui University of Chinese Medicine, Hefei, Anhui, 230012, China.
  2. 2Laboratory of Geriatric Nursing and Health, Anhui University of Chinese Medicine, Hefei, Anhui, 230012, China.
  3. 3Department of Hematology, The Second Xiangya Hospital, Central South University, No.139th Renmin Middle Road, Changsha, Hunan, 410011, China.
  4. 4Department of Nephrology, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, Shanghai, 200032, China.
  5. 5Department of Gastroenterology, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, 230031, China.
  6. 6Geriatric Medical Department, Huangshan City People's Hospital, Huangshan, Anhui, 245200, China.
  7. 7College of Nursing, Anhui University of Chinese Medicine, Hefei, Anhui, 230012, China. [email protected].
  8. 8Laboratory of Geriatric Nursing and Health, Anhui University of Chinese Medicine, Hefei, Anhui, 230012, China. [email protected].
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Abstract

Background

The hemoglobin-to-red blood cell distribution width ratio (HRR) is an inexpensive index derived from routine blood tests, but its relationship with gastrointestinal (GI) cancers in the general population remains unclear.Methods

We pooled NHANES 2001-2018 data (adults ≥ 20 years). GI cancer history was screened using MCQ220 and site-confirmed using site-specific follow-up items for colon, rectal, stomach, esophageal, liver, and pancreatic cancers. HRR was calculated as hemoglobin (g/dL) divided by RDW (%). Survey-weighted logistic regression estimated odds ratios (ORs) and 95% CIs for prevalent GI cancer across HRR (per 0.1-unit increase and tertiles), with restricted cubic splines and subgroup interaction tests. In parallel, eight machine-learning (ML) algorithms were trained and evaluated (70/30 split) to assess predictive performance (AUC, calibration, and decision-curve analysis), with SHAP for interpretability.Results

Among 39,663 participants, 344 had site-confirmed GI cancer. Higher HRR was inversely associated with GI cancers in the fully adjusted model (per 0.1-unit increase: OR 0.86, 95% CI 0.77-0.95; P = 0.003). Participants in the highest HRR tertile had lower odds than the lowest tertile (OR 0.57, 95% CI 0.35-0.93; P = 0.026; P for trend = 0.028). Sex modified the association (P for interaction = 0.002), with an inverse association in men (OR 0.74) but not women. ML models showed similar discrimination (top AUC ≈ 0.82), and SHAP highlighted HRR as an important contributor alongside age.Conclusions

Higher HRR was inversely associated with prevalent, site-confirmed GI cancers in NHANES. In machine-learning analyses, HRR functioned as an informative classification feature.

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Cite

BibTeXRIS
BibTeX
@article{chen2026hemoglobintored,
  title = {{Hemoglobin-to-red blood cell distribution width ratio is inversely associated with prevalent gastrointestinal cancers in NHANES and serves as an informative feature in machine-learning models.}},
  author = {Shiming Chen and Kexin Zhao and Jingxia Zhang and Yingxue Niu and Ran Zou and Min Wang and Yifang Li},
  journal = {BMC cancer},
  year = {2026},
  month = jul,
  doi = {10.1186/s12885-026-16500-6},
  url = {https://europepmc.org/article/MED/42920116},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Hemoglobin-to-red blood cell distribution width ratio is inversely associated with prevalent gastrointestinal cancers in NHANES and serves as an informative feature in machine-learning models.
AU  - Shiming Chen
AU  - Kexin Zhao
AU  - Jingxia Zhang
AU  - Yingxue Niu
AU  - Ran Zou
AU  - Min Wang
AU  - Yifang Li
PY  - 2026
DA  - 2026/07/01
JO  - BMC cancer
DO  - 10.1186/s12885-026-16500-6
UR  - https://europepmc.org/article/MED/42920116
AB  - Background  The hemoglobin-to-red blood cell distribution width ratio (HRR) is an inexpensive index derived from routine blood tests, but its relationship with gastrointestinal (GI) cancers in the general population remains unclear.Methods  We pooled NHANES 2001-2018 data (adults ≥ 20 years). GI cancer history was screened using MCQ220 and site-confirmed using site-specific follow-up items for colon, rectal, stomach, esophageal, liver, and pancreatic cancers. HRR was calculated as hemoglobin (g/dL) divided by RDW (%). Survey-weighted logistic regression estimated odds ratios (ORs) and 95% CIs for prevalent GI cancer across HRR (per 0.1-unit increase and tertiles), with restricted cubic splines and subgroup interaction tests. In parallel, eight machine-learning (ML) algorithms were trained and evaluated (70/30 split) to assess predictive performance (AUC, calibration, and decision-curve analysis), with SHAP for interpretability.Results  Among 39,663 participants, 344 had site-confirmed GI cancer. Higher HRR was inversely associated with GI cancers in the fully adjusted model (per 0.1-unit increase: OR 0.86, 95% CI 0.77-0.95; P = 0.003). Participants in the highest HRR tertile had lower odds than the lowest tertile (OR 0.57, 95% CI 0.35-0.93; P = 0.026; P for trend = 0.028). Sex modified the association (P for interaction = 0.002), with an inverse association in men (OR 0.74) but not women. ML models showed similar discrimination (top AUC ≈ 0.82), and SHAP highlighted HRR as an important contributor alongside age.Conclusions  Higher HRR was inversely associated with prevalent, site-confirmed GI cancers in NHANES. In machine-learning analyses, HRR functioned as an informative classification feature.
SN  - 1471-2407
ER  -