Association of ethylene oxide exposure with all-cause mortality risk among adult population with different stages of diabetes progression

The actual effects of ethylene oxide (EO) exposure on diabetes population are unknown. This prospective study aimed to examine the association of EO with all-cause mortality risk among adults with different stages of diabetes progression. Study participants were selected from NHANES 2013-2018. The mortality was ascertained through linkage to National Death Index files. Data were analyzed using weighted Cox proportional regressions to examine the associations of hemoglobin adducts of EO (HbEO) with all-cause mortality risk. Restricted cubic spline was applied to flexibly model the non-linear association. Results showed the median of follow-up period was 48.0 months. The participants with diabetes had the highest mortality (<i>p</i> = 0.001). The association of all-cause mortality risk with HbEO was overall positive among diabetes (weighted covariates-adjusted HR: 1.089, 95% CI: 1.028-1.155) but not non-diabetes participants. Among diabetes participants, the association was non-linear (p for non-linearity test: 0.023) and was non-significant when the HbEO level was higher than 310.24 pmol/g Hb. In conclusion, EO may increase the mortality risk among diabetes population through aggravating the diabetes-mediated metabolic disorders. The non-linear association found for the first time may reflect the complex physiological effects of the enzymes that contribute to EO endogenous formation or metabolism.