Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, China.
Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
Environ Health. 2022 Mar 9;21(1):32. doi: 10.1186/s12940-022-00841-3.
Plasticizers, also called phthalates, are a group of chemicals widely used in daily life. A previous report showed no significant association between phthalate metabolite concentrations and mortality. We investigated the association of urinary phthalate levels and individual phthalate metabolite levels with all-cause and cardiovascular disease (CVD) mortality after standardizing the phthalate concentration.
A total of 6,625 participants were recruited from a nationally representative sample of adults aged 40 years or older who were enrolled in the National Health and Nutrition Examination Survey (NHANES) between 2003 and 2014 and were followed up through December 31, 2015. Data were analyzed from January 2021 to June 2021. NHANES-linked updated National Death Index public access files were used to acquire information on mortality status and cause of death. The present study conducted extended follow-up of an earlier analysis. Cox proportional hazard models were performed to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) of covariate-adjusted creatinine standardization urinary phthalate concentrations with all-cause and CVD mortality after adjusting for demographics, lifestyle factors and comorbidity variables.
The mean ± standard deviation age of all participants in the final study was 59.9±12.6 years old, and 49.6% of the participants were male. The median follow-up time was 73 months (range 1-157 months). At the censoring date of December 31, 2015, 3,023 participants were identified as deceased (13.4%). A fully adjusted Cox model showed that a urinary di(2-ethylhexyl) phthalate (DEHP) concentration >= 83.4 ng/mL was associated with a slight increase in all-cause mortality (HR 1.27, 95% CI 1.03, 1.57, P for trend= 0.014) and CVD mortality (HR 2.19, 95% CI 1.35, 3.54, P for trend= 0.002). Similarly, urinary mono-2-ethyl-5-carboxypentyl phthalate (MECPP) levels >= 39.2 ng/mL were associated with increased CVD mortality (HR 2.33, 95% CI 1.45, 3.73, P for trend < 0.001). Restricted cubic spline analyses suggested linear associations of DEHP and MECPP levels with all-cause and CVD mortality.
In this large nationally representative sample of American adults, high urinary DEHP and MECPP were significantly associated with all-cause and CVD mortality after adjusting for demographics, lifestyle factors and comorbidity variables.
塑化剂，也称为邻苯二甲酸酯，是一类广泛应用于日常生活中的化学物质。先前的一项报告显示，邻苯二甲酸酯代谢物浓度与死亡率之间没有显著关联。我们研究了标准化后的尿液邻苯二甲酸酯水平和个体邻苯二甲酸酯代谢物水平与全因和心血管疾病（CVD）死亡率之间的关系。
我们从 2003 年至 2014 年参加国家健康和营养检查调查（NHANES）的年龄在 40 岁或以上的具有全国代表性的成年人中招募了 6625 名参与者，并进行了随访，随访至 2015 年 12 月 31 日。数据分析于 2021 年 1 月至 2021 年 6 月进行。使用 NHANES 链接的更新国家死亡指数公共访问文件获取死亡率和死因信息。本研究对早期分析进行了扩展随访。使用 Cox 比例风险模型计算了经过调整后的协变量肌酐标准化尿液邻苯二甲酸酯浓度与全因和 CVD 死亡率之间的风险比（HR）和 95%置信区间（CI），调整了人口统计学、生活方式因素和合并症变量。
最终研究中所有参与者的平均年龄±标准差为 59.9±12.6 岁，49.6%的参与者为男性。中位随访时间为 73 个月（范围 1-157 个月）。在 2015 年 12 月 31 日的截止日期，有 3023 名参与者被确定为死亡（13.4%）。完全调整后的 Cox 模型显示，尿液中邻苯二甲酸二（2-乙基己基）酯（DEHP）浓度>=83.4ng/mL 与全因死亡率略有增加相关（HR 1.27，95%CI 1.03，1.57，P 趋势=0.014）和 CVD 死亡率（HR 2.19，95%CI 1.35，3.54，P 趋势=0.002）。同样，尿液中单-2-乙基-5-羧基戊基邻苯二甲酸酯（MECPP）水平>=39.2ng/mL 与 CVD 死亡率增加相关（HR 2.33，95%CI 1.45，3.73，P 趋势<0.001）。限制性立方样条分析表明，DEHP 和 MECPP 水平与全因和 CVD 死亡率之间存在线性关系。
在这项针对美国成年人的大型全国代表性样本中，尿液中 DEHP 和 MECPP 含量较高与全因和 CVD 死亡率显著相关，调整了人口统计学、生活方式因素和合并症变量后仍然如此。
