Association Between Neutrophil-Lymphocyte Ratio and All-Cause Mortality and Cause-Specific Mortality in US Adults, 1999–2014

Figures & data

Figure 1 Flow chart of inclusion and exclusion of study participants.

Table 1 Baseline Characteristics of Study Participants According to NLR Levels ^a

Characteristics	Total	Low-NLR	High-NLR	P value ^b
No. of participants	32,328	26,320	6008
Age, years	47.4 ± 16.5	46.6 ± 16.1	51.0 ± 18.1	<0.001
Gender
Male	15,844 (48.6)	12,804 (48.3)	3040 (50.2)	<0.01
Female	16,484 (51.4)	13,516 (51.7)	2968 (49.8)
Ethnicity
Non-Hispanic white	16,013 (72)	12,316 (70.5)	3697 (79)	<0.001
Non-Hispanic black	6282 (10.1)	5582 (11.0)	700 (5.8)
Mexican American	5671 (7.5)	4749 (7.8)	922 (6.1)
Others	4362 (10.4)	3673 (10.7)	689 (9.1)
Smoking status
Never smoker	16,965 (52.3)	14,078 (53.4)	2887 (47.0)	<0.001
Former smoker	8427 (25.5)	6566 (24.6)	1861 (29.6)
Current smoker	6936 (22.3)	5676 (22.0)	1260 (23.4)
Alcohol drinking
Non-drinker or low drinker	9394 (24.4)	7647 (24.4)	1747 (24.3)	0.93
Heavy drinker	22,934 (75.6)	18,673 (75.6)	4261 (75.7)
Education
Less than high school	8733 (17.5)	7167 (17.5)	1566 (17.3)	0.003
High school or equivalent	7459 (23.8)	6000 (23.4)	1459 (25.5)
College or above	16,136 (58.7)	13,153 (59.0)	2983 (57.1)
Marital status
Married	19,993 (65.4)	16,380 (66.2)	3613 (61.6)	<0.001
Separated	7313 (19.0)	5767 (18.1)	1546 (23.4)
Never married	5022 (15.6)	4173 (15.7)	849 (15.0)
Family income-poverty ratio level
0–1.0	6835 (14.3)	5623 (14.4)	1212 (13.9)	<0.001
1.1–2.9	13,192 (35.6)	10,611 (35.1)	2581 (38.3)
≥3.0	12,301 (50.1)	10,086 (50.5)	2215 (47.8)
BMI
<18.5	480 (1.5)	357 (1.4)	123 (1.9)	<0.001
18.5–24.9	9964 (32.3)	7911 (31.9)	2053 (34.4)
25–29.9	11,397 (34.9)	9364 (35.3)	2033 (32.9)
≥30	10,487 (31.3)	8688 (31.4)	1799 (30.8)
Self-reported health
Very good to excellent	13,673 (50.0)	11,272 (51.0)	2401 (45.3)	<0.001
Good	11,170 (33.0)	9144 (32.9)	2026 (33.7)
Poor to fair	7485 (17.0)	5904 (16.1)	1581 (21.0)
Self-reported chronic diseases
Cancer	3015 (9.3)	2194 (8.5)	821 (13.2)	<0.001
Diabetes	5434 (12.6)	4313 (11.9)	1121 (15.6)	<0.001
Chronic kidney disease	4452 (10.5)	3273 (9.3)	1179 (16.2)	<0.001
Cardiovascular diseases	3636 (8.8)	2608 (7.7)	1028 (13.8)	<0.001
Hypertension	13,777 (37.6)	10,936 (36.2)	2841 (44.0)	<0.001
Hyperlipemia	19,904 (60.9)	16,152 (60.9)	3752 (60.9)	0.92
COPD	1403 (4.2)	1012 (3.7)	391 (6.2)	<0.001

Notes: ^aAll estimates accounted for complex survey designs. Values are numbers (percentages) unless stated otherwise. ^b For categorical variables, P value was calculated by weighted chi-square test. For continuous variables, P value was calculated by weighted linear regression model.

Abbreviations: NLR, neutrophil-lymphocyte ratio; COPD, chronic obstructive pulmonary diseases; BMI, body mass index.

Table 2 Association of NLR Levels with All-Cause Mortality and Cause-Specific Mortality ^a

Variable	NLR Level, Hazard Ratio (95% CI)
	Continuous NLR	Low-NLR	High-NLR
Median NLR level	2	1.81	3.7
All-cause mortality
Deaths per person-years	4092 per 254,580	2581 per 209,036	1241 per 45,544
Non-adjusted model	1.22 (1.18, 1.26)	1 [Reference]	2.20 (1.83, 2.64)
Model 1	1.12 (1.08, 1.16)	1 [Reference]	1.53 (1.27, 1.85)
Model 2	1.12 (1.08, 1.17)	1 [Reference]	1.52 (1.26, 1.83)
Model 3	1.11 (1.06, 1.16)	1 [Reference]	1.43 (1.18, 1.73)
Cancer mortality
Deaths per person-years	884 per 254,580	642 per 209,036	242 per 45,544
Non-adjusted model	1.17 (1.06, 1.29)	1 [Reference]	1.79 (1.20, 2.67)
Model 1	1.06 (0.95, 1.19)	1 [Reference]	1.30 (0.86, 1.95)
Model 2	1.07 (0.96, 1.20)	1 [Reference]	1.31 (0.87, 1.97)
Model 3	1.05 (0.93, 1.19)	1 [Reference]	1.27 (0.84, 1.92)
CVD mortality
Deaths per person-years	904 per 254,580	622 per 209,036	282 per 45,544
Non-adjusted model	1.24 (1.16, 1.32)	1 [Reference]	2.49 (1.68, 3.70)
Model 1	1.11 (1.02, 1.21)	1 [Reference]	1.55 (1.04, 2.32)
Model 2	1.12 (1.03, 1.22)	1 [Reference]	1.56 (1.04, 2.33)
Model 3	1.09 (0.99, 1.19)	1 [Reference]	1.44 (0.96, 2.16)

Notes: ^aAll estimates accounted for complex survey designs. Model 1 was adjusted for baseline age, sex. Model 2 was additionally adjusted for race/ethnicity, education level, marital status, family income poverty ratio level, drinking status, and smoking status. Model 3 was further adjusted for body mass index, and self-reported general health.

Abbreviations: NLR, neutrophil-lymphocyte ratio; CVD, cardiovascular disease.

Figure 2 Kaplan-Meier Curves for Survival Probability, with Follow-up in Years. Survival according to NLR levels was determined using Kaplan Meier curves. Participants with higher NLR levels (NLR ≥3, red line) had unfavorable prognosis compared with those with lower (NLR < 3, blue line).

Table 3 Stratified Analyses for the Association of NLR Levels with All-Cause Mortality ^a

Variable	NLR Level, Hazard Ratio (95% CI)		P value for Interaction
	Low-NLR	High-NLR
Age
<60	1 [Reference]	1.40 (0.94, 2.08)	0.42
≥60	1 [Reference]	1.63 (1.31, 2.02)
Gender
Male	1 [Reference]	1.33 (1.03, 1.72)	0.42
Female	1 [Reference]	1.58 (1.20, 2.09)
Ethnicity
Non-Hispanic white	1 [Reference]	1.39 (1.13, 1.71)	0.91
Non-Hispanic black	1 [Reference]	1.74 (0.85, 3.55)
Mexican American	1 [Reference]	1.51 (0.61, 3.75)
Others	1 [Reference]	1.24 (0.55, 2.83)
Smoking status
Never smoker	1 [Reference]	1.34 (0.99, 1.84)	0.8
Former smoker	1 [Reference]	1.55 (1.15, 2.08)
Current smoker	1 [Reference]	1.36 (0.90, 2.06)
BMI
<18.5	1 [Reference]	1.25 (0.37, 4.25)	0.99
18.5–24.9	1 [Reference]	1.39 (1.00, 1.92)
25–29.9	1 [Reference]	1.48 (1.07, 2.04)
>30	1 [Reference]	1.48 (1.03, 2.11)

Notes: ^aAll estimates accounted for complex survey designs. Risk estimates were adjusted for baseline age, sex, race/ethnicity, education level, marital status, family income poverty ratio level, drinking and smoking status, body mass index, and self-reported general health. And group variables were not adjusted for in that subgroup analysis.

Abbreviations: NLR, neutrophil-lymphocyte ratio; BMI, body mass index.