Sex difference in the non-linear relationship between ethylene oxide exposure and depressive symptoms: A cross-sectional study

Background: Ethylene oxide (EO) has been recognized as an animal carcinogen and environmental EO exposure was linked to several diseases. However, the association of EO exposure with depression prevalence is still not clear.Methods: We included 6016 participants with complete data on HbEO concentrations, depression diagnosis, and necessary covariates using the 2013-2020 National Health and Nutrition Examination Survey. Weighted multivariable logistic model was applied to examine the association of HbEO concentrations with depression risk. Weighted restricted cubic spline model was applied to draw the dose-response curve.Results: In the total population, individuals in the second, third, and fourth quartile of HbEO respectively had an adjusted OR of 0.99 (95%CI: 0.60, 1.63), 1.13 (95%CI: 0.73, 1.75), and 2.87 (95%CI: 1.86, 4.45) (P-trend < 0.001) for depression with a significant "J" shaped non-linear dose-response relationship (Pnon-linear < 0.001). Females, drinkers, and smokers were susceptible to the depressive effect of EO. Doubling the HbEO concentrations was respectively associated with a 1.50-fold (95%CI: 1.25, 1.79), 1.29-fold (1.15, 1.44), and 1.17-fold (1.04, 1.33) increased risk of depression for females, drinkers, and smokers.Limitations: Cross-sectional study design and self-reported depressive symptoms.Conclusions: Environmental EO exposure was associated with increased depression risk, especially among females, drinkers, and smokers. Further prospective studies are required to affirm these findings.