Abstract
<title>Abstract</title> <p>Background The uric acid-to-high-density lipoprotein cholesterol ratio (UHR) is a novel inflammatory and metabolic biomarker, but its association with chronic obstructive pulmonary disease (COPD) in older adults remains unclear. This study investigated the relationship between UHR and COPD prevalence among adults aged ≥ 60 years. Methods This cross-sectional study analyzed 5,277 participants aged ≥ 60 years from NHANES 2013–2018. Weighted multivariable logistic regression estimated the UHR–COPD association. Restricted cubic spline (RCS) analysis characterized the dose–response relationship, and receiver operating characteristic (ROC) curves evaluated model performance. Subgroup, sensitivity, and machine learning analyses were conducted. Results Of 5,277 participants, 404 (7.7%) had COPD. Elevated UHR was independently associated with higher COPD prevalence. In the fully adjusted model, each standard deviation (SD) increase in UHR corresponded to 23% higher odds (OR 1.23; 95% CI 1.05–1.44; P = 0.015). The highest versus lowest UHR quartile showed significantly higher risk (OR 1.71; 95% CI 1.09–2.68; P for trend = 0.019). RCS confirmed a linear dose–response relationship (P for non-linearity = 0.449). The model had good discrimination (AUC = 0.785), and machine learning identified UHR as a key predictor. Conclusions Elevated UHR is associated with increased COPD prevalence in older adults. UHR may serve as a cost-effective auxiliary biomarker for risk stratification and COPD screening in geriatric care.</p>