Investigating the association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio and tinnitus: Evidence from a nationally representative observational study

Background: Tinnitus, a condition with substantial psychological and physical implications, significantly impacts quality of life; however, its relationship with lipid metabolism remains underexplored. Methods: This population-based observational study included 4991 participants. Weighted multivariate logistic regression and restricted cubic spline (RCS) analyses were employed to assess the relationship between the nonhigh-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and tinnitus. Subgroup and sensitivity analyses were conducted to evaluate the consistency and robustness of findings across sociodemographic and health-related subgroups. Results: A total of 791 participants reported tinnitus, with a prevalence of 15.85 %. A significant positive association was observed between NHHR and tinnitus risk. In the final model with all covariates adjusted, when NHHR increased by one unit, the risk of tinnitus would increase by 12 % (odds ratio [OR] = 1.12, 95 % confidence interval (CI), 1.02-1.22, P = 0.022). Compared to the lowest NHHR tertile, the highest NHHR tertile had a higher risk of tinnitus (OR = 1.46; 95 % CI, 1.02-2.07, P = 0.040). RCS analysis revealed that NHHR was linearly associated with tinnitus (P for nonlinearity = 0.923). Subgroup analyses confirmed that this association remained stable across various sociodemographic and health subgroups (P for interaction >0.05). Conclusions: These findings suggest that NHHR is positively and linearly associated with tinnitus risk, highlighting the essential role of NHHR in the development of tinnitus. The findings underscore the need for integrated metabolic and psychosomatic approaches in tinnitus prevention and management.