Association between endocrine disrupting chemicals exposure and the risk of all-cause mortality in individuals with diabetes mellitus or its complications: A prospective cohort study
Objective: To investigate the association between exposure to endocrine disrupting chemicals (EDCs) and all-cause mortality in individuals with diabetes mellitus (DM) in U.S., including those with diabetic complications. Methods: This prospective cohort study included participants with DM in the 199...
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Elsevier
2025-06-01
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| author | Yueheng Zhang Zilong Zhang Feiyang Zhou Guangchao Xu Weichao Huang Maoyang Wang Yuanqi Lan Wei Zhang Zhiyuan Liu Shusen Chang Shi Qiu Fang Qi Zairong Wei |
| author_facet | Yueheng Zhang Zilong Zhang Feiyang Zhou Guangchao Xu Weichao Huang Maoyang Wang Yuanqi Lan Wei Zhang Zhiyuan Liu Shusen Chang Shi Qiu Fang Qi Zairong Wei |
| author_sort | Yueheng Zhang |
| collection | DOAJ |
| description | Objective: To investigate the association between exposure to endocrine disrupting chemicals (EDCs) and all-cause mortality in individuals with diabetes mellitus (DM) in U.S., including those with diabetic complications. Methods: This prospective cohort study included participants with DM in the 1999–2018 National Health and Nutritional Examination Survey. Data on mortality was obtained from national death records up to December 31, 2019. Cox regression, WQS regression and LASSO regression were constructed to examine the associations between EDCs and all-cause mortality in individuals with DM or its complications, adjusted for potential confounders. Restricted cubic spline analysis was used to investigate the linear relationship. Subgroup analyses were also tested in prespecified subgroups of interest. Results: The study included 3,453 participants. Mono-(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP), mono-(2-ethyl-5-oxohexyl) phthalate (MEOHP), and mono-2-ethyl-5-carboxypentyl phthalate (MECPP) showed positive associations with all-cause mortality (MEHHP: 1.14 (CI1.00–1.29); MEOHP: 1.14 (CI 1.00–1.30); MECPP: 1.17 (CI 1.00–1.37)). These also exhibited positive associations with all-cause mortality in the participants with diabetic kidney disease (MEHHP: 1.24 (CI 1.08–1.42); MEOHP: 1.27 (CI 1.10–1.47); MECPP: 1.43 (CI 1.19–1.71)). Bisphenol A 1.45 (1.08, 1.96) and MCPP 1.59 (CI 1.24–2.05) showed positive associations with all-cause mortality in the diabetic retinopathy (DR) participants. MEHHP exposure interacted with hypertension in DM and hypercholesterolemia, as well as with age in DR populations. MCPP exposure interacted with age in DR, significantly amplifying mortality risks (P interaction < 0.05). Conclusions: This study provided epidemiological evidence that higher concentrations of certain EDCs are associated with an increased risk of all-cause mortality in participants with DM or its complications. |
| format | Article |
| id | doaj-art-b7559d0efd71405598e4ed9f10bab69e |
| institution | Kabale University |
| issn | 0160-4120 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Elsevier |
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| series | Environment International |
| spelling | doaj-art-b7559d0efd71405598e4ed9f10bab69e2025-08-20T03:24:48ZengElsevierEnvironment International0160-41202025-06-0120010955610.1016/j.envint.2025.109556Association between endocrine disrupting chemicals exposure and the risk of all-cause mortality in individuals with diabetes mellitus or its complications: A prospective cohort studyYueheng Zhang0Zilong Zhang1Feiyang Zhou2Guangchao Xu3Weichao Huang4Maoyang Wang5Yuanqi Lan6Wei Zhang7Zhiyuan Liu8Shusen Chang9Shi Qiu10Fang Qi11Zairong Wei12Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, China; The 2011 Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, China; The Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine, Zunyi Medical University, Zunyi, Guizhou 563000, ChinaDepartment of Urology, Institute of Urology and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, Sichuan Province, ChinaDepartment of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, China; The 2011 Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, China; The Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine, Zunyi Medical University, Zunyi, Guizhou 563000, ChinaDepartment of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, China; The 2011 Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, China; The Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine, Zunyi Medical University, Zunyi, Guizhou 563000, ChinaDepartment of Urology, Institute of Urology and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, Sichuan Province, ChinaDepartment of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, China; The 2011 Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, China; The Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine, Zunyi Medical University, Zunyi, Guizhou 563000, ChinaDepartment of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, China; The 2011 Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, China; The Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine, Zunyi Medical University, Zunyi, Guizhou 563000, ChinaDepartment of Urology, Institute of Urology and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, Sichuan Province, ChinaDepartment of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, China; The 2011 Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, China; The Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine, Zunyi Medical University, Zunyi, Guizhou 563000, ChinaDepartment of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, ChinaDepartment of Urology, Institute of Urology and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China; Corresponding author at: Department of Urology, Institute of Urology and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China (S. Qiu). Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, the 2011 Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine, Affiliated Hospital of Zunyi Medical University; the Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine, Zunyi Medical University, Zunyi, Guizhou 563000, China (F. Qi).Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, China; The 2011 Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, China; The Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine, Zunyi Medical University, Zunyi, Guizhou 563000, China; Corresponding author at: Department of Urology, Institute of Urology and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China (S. Qiu). Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, the 2011 Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine, Affiliated Hospital of Zunyi Medical University; the Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine, Zunyi Medical University, Zunyi, Guizhou 563000, China (F. Qi).Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, China; The 2011 Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, China; The Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine, Zunyi Medical University, Zunyi, Guizhou 563000, China; Corresponding author at: Department of Urology, Institute of Urology and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China (S. Qiu). Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, the 2011 Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine, Affiliated Hospital of Zunyi Medical University; the Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine, Zunyi Medical University, Zunyi, Guizhou 563000, China (F. Qi).Objective: To investigate the association between exposure to endocrine disrupting chemicals (EDCs) and all-cause mortality in individuals with diabetes mellitus (DM) in U.S., including those with diabetic complications. Methods: This prospective cohort study included participants with DM in the 1999–2018 National Health and Nutritional Examination Survey. Data on mortality was obtained from national death records up to December 31, 2019. Cox regression, WQS regression and LASSO regression were constructed to examine the associations between EDCs and all-cause mortality in individuals with DM or its complications, adjusted for potential confounders. Restricted cubic spline analysis was used to investigate the linear relationship. Subgroup analyses were also tested in prespecified subgroups of interest. Results: The study included 3,453 participants. Mono-(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP), mono-(2-ethyl-5-oxohexyl) phthalate (MEOHP), and mono-2-ethyl-5-carboxypentyl phthalate (MECPP) showed positive associations with all-cause mortality (MEHHP: 1.14 (CI1.00–1.29); MEOHP: 1.14 (CI 1.00–1.30); MECPP: 1.17 (CI 1.00–1.37)). These also exhibited positive associations with all-cause mortality in the participants with diabetic kidney disease (MEHHP: 1.24 (CI 1.08–1.42); MEOHP: 1.27 (CI 1.10–1.47); MECPP: 1.43 (CI 1.19–1.71)). Bisphenol A 1.45 (1.08, 1.96) and MCPP 1.59 (CI 1.24–2.05) showed positive associations with all-cause mortality in the diabetic retinopathy (DR) participants. MEHHP exposure interacted with hypertension in DM and hypercholesterolemia, as well as with age in DR populations. MCPP exposure interacted with age in DR, significantly amplifying mortality risks (P interaction < 0.05). Conclusions: This study provided epidemiological evidence that higher concentrations of certain EDCs are associated with an increased risk of all-cause mortality in participants with DM or its complications.http://www.sciencedirect.com/science/article/pii/S0160412025003071Diabetogenic environmentEndocrine disrupting chemicalsChronic complicationsMortality |
| spellingShingle | Yueheng Zhang Zilong Zhang Feiyang Zhou Guangchao Xu Weichao Huang Maoyang Wang Yuanqi Lan Wei Zhang Zhiyuan Liu Shusen Chang Shi Qiu Fang Qi Zairong Wei Association between endocrine disrupting chemicals exposure and the risk of all-cause mortality in individuals with diabetes mellitus or its complications: A prospective cohort study Environment International Diabetogenic environment Endocrine disrupting chemicals Chronic complications Mortality |
| title | Association between endocrine disrupting chemicals exposure and the risk of all-cause mortality in individuals with diabetes mellitus or its complications: A prospective cohort study |
| title_full | Association between endocrine disrupting chemicals exposure and the risk of all-cause mortality in individuals with diabetes mellitus or its complications: A prospective cohort study |
| title_fullStr | Association between endocrine disrupting chemicals exposure and the risk of all-cause mortality in individuals with diabetes mellitus or its complications: A prospective cohort study |
| title_full_unstemmed | Association between endocrine disrupting chemicals exposure and the risk of all-cause mortality in individuals with diabetes mellitus or its complications: A prospective cohort study |
| title_short | Association between endocrine disrupting chemicals exposure and the risk of all-cause mortality in individuals with diabetes mellitus or its complications: A prospective cohort study |
| title_sort | association between endocrine disrupting chemicals exposure and the risk of all cause mortality in individuals with diabetes mellitus or its complications a prospective cohort study |
| topic | Diabetogenic environment Endocrine disrupting chemicals Chronic complications Mortality |
| url | http://www.sciencedirect.com/science/article/pii/S0160412025003071 |
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