the high-sensitivity C-reactive protein (hs-CRP) to high-density lipoprotein cholesterol (HDL-C) ratio and hyperuricemia among the population of the United States, the ratio still has predictive value for cardiovascular disease in middle age. Methods 4,780 adult participators from the National Health and Nutrition Examination Survey (NHANES) were involved in this research. Through the NHANES laboratory testing, all biochemical indications were discovered. In order to observe the differences in indications, propensity score methods were used to match age and sex confounders.The relationship between hs-CRP/HDL-C ratio and hyperuricemia was explored using propensity matching and weighted multivariate logistic regression analysis, with the potential nonlinear relationship between hs-CRP/HDL-C ratio and hyperuricemia was investigated using a restricted cubic spline test. Results Sex, age, hypercholesterolaemia, diabetes, fasting glucose, cholesterol, high and low density lipoprotein, did not differ statistically significantly (P >
0.05)
however, uric acid, triglycerides, high-density lipoprotein, CRP/HDL ratio, C-reactive protein, ethnicity, and hypertriglyceridemia differed (P <
0.05). In a weighted multifactor model, the relative odds ratio for hyperuricemia increased by 0.383 times at the second quintile (OR = 1.383, 95%CI(1.382-1.385), P <
0.001), 2.001 times at the third quintile (OR = 3.001, 95%CI (2.998-3.005), P <
0.001), and 2.533 times at the fourth quintile (OR = 3.533, 95%CI (3.529-3.538), P <
0.001). In the univariate and multivariate models, the restricted cubic spline test demonstrated a nonlinear correlation between the CRP/HDL ratio and hyperuricaemia, with a growing "log-function" shaped trend (P for overall <
0.001). Conclusion The hs-CRP/HDL-C ratio is significantly positively correlated with hyperuricemia among American adults. Maintaining the ideal hs-CRP/HDL-C ratio may contribute to reducing the burden of hyperuricemia.