BRIEF RESEARCH REPORT article
Front. Public Health
Sec. Public Mental Health
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1638290
This article is part of the Research TopicDiagnosis, Treatment or Prediction of Biomarkers in DepressionView all 4 articles
Association Between Hemoglobin-to-Red Cell Distribution Width Ratio and Depression in Chinese Adults: A Population-Based Cross-Sectional Study
Provisionally accepted
- 1West China Hospital of Sichuan University, Chengdu, China
- 2Sichuan University West China School of Medicine, Chengdu, China
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Objective: Investigating the hemoglobin-to-red blood cell distribution width ratio (HRR) and its association with depression risk in Chinese adults, addressing a gap in evidence for non-elderly populations and exploring potential effect modifiers. Methods: In this cross-sectional analysis of 30,427 adults from routine health screenings （2020.07–2021.06), depression was assessed using the Self-Rating Depression Scale. HRR was calculated as hemoglobin (g/dL) divided by red cell distribution width (%). Multivariable logistic regression, RCS , sensitivity analyses with alternative depression definitions, E-value analysis, and ROC curve were conducted, adjusted for confounders. Results: In a population of 30,427 adults (46.3% female; mean age 44.9 ± 10.7 years; 56.7% with college education or above) undergoing routine health screenings, a strong inverse dose-response relationship was observed between HRR and depression risk. Each unit increase in HRR reduced depression risk by 39% in fully adjusted models (OR=0.61, 95% CI:0.51–0.72, p<0.0001).After adjusting covariates, compared to the lowest quartile (Q1: HRR ≤1.031), participants in Q2 (1.031-1.142), Q3 (1.142-1.25), and Q4 (≥1.25) exhibited 10% (OR=0.90, 95% CI:0.84-0.98), 13% (OR=0.87, 95% CI:0.80-0.94), and 24% (OR=0.76, 95% CI:0.70-0.83,) reductions in depression risk, respectively. (p-trend<0.0001). Age modified the relationship (p-interaction=0.004), with stronger protection in adults ≥45 years (OR=0.40, 95% CI:0.32–0.51) than younger individuals (OR=0.64, 95% CI:0.50–0.82). Conclusion: HRR may indicate an independent, linear inverse association with depression risk in Chinese adults, with strong effects in older populations. As a cost-effective biomarker, HRR could support depression risk stratification and prevention strategies, particularly in aging groups, and these findings warrant validation in prospective studies.
Keywords: Hemoglobin-to-red cell distribution width ratio (HRR), Depression, Graded statistical association, Chinese population, Cross-sectional study
Received: 30 May 2025; Accepted: 02 Sep 2025.
Copyright: © 2025 Zhou, Xu, Zhang and Liu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Junteng Zhou, West China Hospital of Sichuan University, Chengdu, China
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