Response of platelet count in the US population following exposure to BDEs and BB: A cross-sectional analysis of database of NHANES (2007–2016)

Brominated flame retardants (BFRs) are environmental pollutants linked to health risks, including increased platelet (PLT) levels that may elevate the risk of thrombosis and cardiovascular diseases. This study examined the association between BFR exposure and PLT levels among 5831 adult participants from the National Health and Nutrition Examination Survey (NHANES) (2007-2016). Of the 12 BFRs analyzed, BB153, BDE17, BDE85, BDE154, BDE183, and BDE209 showed significant positive correlations with PLT levels (p < 0.05), with BDE17 demonstrating the strongest correlation (Spearman's coefficient = 0.122). After adjusting for confounders, all BFRs except BDE153 remained significantly associated with elevated PLT levels. Restricted cubic spline analysis indicated varying associations, with BDE99, BDE183, and BDE209 showing an "S"-shaped relationship, while BB153, BDE17, and BDE66 presented an inverted "J"-shaped relationship. BDE153 exhibited a "U"-shaped relationship with PLT level. Both weighted quantile sum regression and quantile-based g-computation confirmed that BFR mixtures positively correlated with PLT levels, with BDE17 as the most significant contributor. Our findings suggest that BFR exposure is associated with increased PLT levels, indicating a potential risk for thrombosis and related cardiovascular conditions.