Hygiene and environmental health advances最新文献

{"title":"Exposure to cadmium and cerebrovascular mortality in the United States","authors":"Xin Wang ,&nbsp;Ziqin Cao ,&nbsp;Kelly M. Bakulski ,&nbsp;Henry L. Paulson","doi":"10.1016/j.heha.2025.100156","DOIUrl":"10.1016/j.heha.2025.100156","url":null,"abstract":"<div><h3>Background</h3><div>Cerebrovascular diseases are a leading cause of death in the U.S., and emerging evidence suggests that environmental toxicants such as cadmium may contribute to cerebrovascular risk. This study investigates the association between cadmium exposure and cerebrovascular mortality in a nationally representative sample of U.S. adults.</div></div><div><h3>Methods</h3><div>We analyzed data from adults aged ≥40 years in the National Health and Nutrition Examination Survey (NHANES) 1999–2016 cycles, with mortality follow-up through 2019. Blood cadmium was measured in 23,455 participants, and urinary cadmium was measured in 8929 participants. Cerebrovascular deaths were identified through linkage with the National Death Index. Survey-weighted Cox proportional hazards models evaluated associations between cadmium concentrations and cerebrovascular mortality.</div></div><div><h3>Results</h3><div>Over a mean follow-up of 10.2 years, 247 cerebrovascular deaths were observed. Each interquartile range increase in blood cadmium (0.40 µg/L) was associated with a 23 % higher risk of cerebrovascular mortality (HR = 1.23, 95 % CI: 1.04–1.46). Urinary cadmium was also associated with higher cerebrovascular mortality, although marginally significant (HR = 1.36 per doubling, 95 % CI: 0.99–1.87). Associations appeared stronger among former and current smokers, though interaction terms were not statistically significant.</div></div><div><h3>Conclusions</h3><div>Cadmium exposure is associated with increased cerebrovascular mortality in the U.S. population. These findings support cadmium as a modifiable environmental risk factor and underscore the need for public health interventions to reduce exposure through tobacco control, dietary regulations, and environmental policy.</div></div>","PeriodicalId":73269,"journal":{"name":"Hygiene and environmental health advances","volume":"16 ","pages":"Article 100156"},"PeriodicalIF":2.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145268132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of particulate matter exposure associated with biomass storage in urban heating plant","authors":"Daniel Tomčík ,&nbsp;Miloš Gejdoš","doi":"10.1016/j.heha.2025.100154","DOIUrl":"10.1016/j.heha.2025.100154","url":null,"abstract":"<div><div>This study assessed the airborne particulate matter (PM) in urban heating plants, potentially affecting respiratory health in workers and nearby residents. The objectives of this study were to characterize occupational exposure during chip-loading activities and to evaluate ambient PM concentrations in the surrounding environment. Occupational exposure was assessed in accordance with the relevant standards using the Temtop M2000C, while continuous ambient monitoring was conducted with the AirNote device. The results indicate a significant increase in PM concentrations during woodchip loading activities. Mean PM2.5 concentrations were 24.03 µg/m³ during loading and 8.07 µg/m³ during non-loading, while PM10 levels were 38.75 µg/m³ and 12.80 µg/m³, respectively. Continuous monitoring revealed that daily mean PM2.5 concentrations were above the WHO 24-h guideline value of 15 µg/m³ on 3 days. The maximum daily mean PM2.5 concentration was 43.7 µg/m³, while the median daily mean was 22.5 µg/m³. For PM10, the maximum daily mean reached 70.9 µg/m³ and the median daily mean was 35.6 µg/m³, with exceedance of the WHO 24-hour guideline of 45 µg/m³ observed on one day. Distance from the woodchip pile also had a significant effect on PM concentrations (<em>p</em> &lt; 0.001), with short-term mean levels at 50 m exceeding the WHO 24-h guideline value by 2.9 times for PM2.5 and 1.6 times for PM10. These guideline values are provided for context only, as they represent 24-hour mean concentrations and not instantaneous limits. Beyond 100 m, no further significant reduction in PM levels was observed. Biomass storage operations can cause temporary PM exceedances, particularly during handling and near storage areas. These findings underscore the importance of implementing mitigation strategies to reduce airborne particulate emissions.</div></div>","PeriodicalId":73269,"journal":{"name":"Hygiene and environmental health advances","volume":"16 ","pages":"Article 100154"},"PeriodicalIF":2.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145268131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Air pollution mixtures and stillbirth: k-means cluster analysis","authors":"Naomi O. Riches ,&nbsp;Ramkiran Gouripeddi ,&nbsp;Robert M. Silver ,&nbsp;Julio C. Facelli","doi":"10.1016/j.heha.2025.100153","DOIUrl":"10.1016/j.heha.2025.100153","url":null,"abstract":"<div><h3>Background</h3><div>Preventing stillbirths starts with identifying modifiable risk factors, such as air pollution (AP). Most research has focused on individual components of AP (e.g. PM_2.5) to assess the linear relationship between air pollutant concentration and stillbirth, with mixed results. However, the air we breathe is a mixture of gases and particles. The purpose of this study was to assess how mixtures of criteria air pollutants are associated with stillbirth in the United States.</div></div><div><h3>Materials and Methods</h3><div>Air pollution data from the US Environmental Protection Agency and individual US birth and fetal death data from the CDC National Vital Statistics System were used. Air pollutant exposures were clustered using k-means clustering. A categorical variable linking each patient to one of these clusters was used in a regression analysis.</div></div><div><h3>Results</h3><div>Four AP clusters were identified through k-means. Exposure to air pollution mixtures included in Clusters 1, 2, and 4 during pregnancy was associated with a 40%, 13%, and 43% increase in the odds of stillbirth, compared to Cluster 3 (reference), (OR = 1.40, 95% CI: 1.36-1.44, p&lt;0.001; OR = 1.13, 95% CI: 1.09-1.16, p&lt;0.001; OR = 1.43, 95% CI: 1.38-1.49, p&lt;0.001), respectively.</div></div><div><h3>Discussion</h3><div>The air pollution cluster associated with the greatest odds of stillbirth was high in PM_2.5 and SO₂, which may indicate industrial sources. To our knowledge, this is the first study to assess the impact of air pollution mixtures on stillbirth using k-means clustering. This method can be used to identify non-linear relationships between mixtures of air pollution and a health outcome.</div></div>","PeriodicalId":73269,"journal":{"name":"Hygiene and environmental health advances","volume":"16 ","pages":"Article 100153"},"PeriodicalIF":2.7,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145159073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unraveling co-contamination characteristics of heavy metals in soil-crop system and collaborative management of their health risk across China","authors":"Wenzhuo Deng ,&nbsp;Fei Li ,&nbsp;Xiyao Chen ,&nbsp;Jinyuan Guo ,&nbsp;Chang Gao ,&nbsp;Junrui Zhao ,&nbsp;Tianwei Sun ,&nbsp;Jingdong Zhang","doi":"10.1016/j.heha.2025.100151","DOIUrl":"10.1016/j.heha.2025.100151","url":null,"abstract":"<div><div>Heavy metal pollution in farmland soil and crops directly affects the food safety and public health. A comprehensive national-scale assessment from an integrated soil-crop perspective in China remains limited. To address this gap, this study conducted a systematic review using an optimized bibliometric approach enhanced with uncertainty control and case mining. 1157 publications reporting on eight heavy metals (As, Cd, Cr, Cu, Hg, Ni, Pb, and Zn) in agricultural soils, grains, and vegetables across China were analyzed. Key findings include: (1) Cadmium (Cd) was the most widespread pollutant in soils, whereas mercury (Hg) showed highly concentrated hotspots. (2) A discrepancy was observed between soil pollution levels and the corresponding crop contamination indicating that the relationship between them is not fully synergistic. (3) Health risk assessment revealed that the total carcinogenic risk from soil exposure (10⁻⁶ - 10⁻⁵) was significantly lower than that from ingestion of contaminated grains and vegetables (10⁻⁴ - 10⁻³). Arsenic (As) and Cd were identified as the primary risk contributors in most provinces. (4) Geographically, integrated high-risk areas were classified as Class I (Guangdong, Guizhou, Yunnan) and Class II (Hunan). Risk sources in Yunnan and Guizhou were attributed to both geogenic and anthropogenic activities, with exposure dominated by vegetable and grain ingestion, respectively. In contrast, risks in Guangdong and Hunan were primarily linked to human activities (industrial, mining, and agricultural), with comparable exposure from both crops. Based on these findings, tailored risk mitigation strategies are proposed for the identified high-risk provinces, considering their distinct exposure pathways and contamination sources.</div></div>","PeriodicalId":73269,"journal":{"name":"Hygiene and environmental health advances","volume":"16 ","pages":"Article 100151"},"PeriodicalIF":2.7,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145159072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unravelling the crucial aging signatures linking cadmium exposure with the risk of frailty and mortality: DNA methylation aging clocks, biological aging indicators, or telomere length?","authors":"Yayuan Mei ,&nbsp;Weitao Su ,&nbsp;Jiaxin Zhao ,&nbsp;Quan Zhou ,&nbsp;Xiuzhi Li ,&nbsp;Yanbing Li ,&nbsp;Ming Yang ,&nbsp;Jingtao Wu ,&nbsp;Yaoyu Hu ,&nbsp;Ang Li","doi":"10.1016/j.heha.2025.100149","DOIUrl":"10.1016/j.heha.2025.100149","url":null,"abstract":"<div><div>We aimed to investigate whether heavy metal exposure is associated with aging acceleration and aging-related outcomes, and whether aging mediates such associations. 6583 participants from a 20-year nationally representative cohort study were included. Blood levels of two typical heavy metals, cadmium (Cd) and lead (Pb), were measured. Eleven aging signatures were assessed, including DNA methylation aging clocks, biological aging indicators, and telomere length. Survey-weighted Cox proportional hazard models, generalized linear models, and logistic regression models were used to evaluate the effects of metals on aging and related outcomes. An unsupervised machine learning algorithm was applied to identify aging-featured clusters. The role of aging acceleration in metal-associated frailty and mortality was tested using average causal mediation effect analysis. We found that Cd was associated with both frailty and mortality risk, and Pb was associated with mortality risk. Significant associations with multiple aging signatures were mainly observed for Cd exposure. Participants were categorized into four clusters. Finally, aging signatures mediated Cd-associated frailty and mortality with mediation proportions ranging from 4.37% to 43.61%. Our findings reveal that Cd exposure is associated with aging acceleration, frailty, and mortality risk. Aging mediated the Cd-associated frailty and mortality, which highlights the potential mechanisms and prevention avenues.</div></div>","PeriodicalId":73269,"journal":{"name":"Hygiene and environmental health advances","volume":"16 ","pages":"Article 100149"},"PeriodicalIF":2.7,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145221337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unveiling the mediating role of oxidative stress in the association between endocrine-disrupting chemicals and phenotypic age acceleration: a cross-sectional study","authors":"Ziang Guo ,&nbsp;Yuxuan Tan ,&nbsp;Feng Huang ,&nbsp;Jiyu Nie ,&nbsp;Xiaoxiao Lin ,&nbsp;Yingyin Fu ,&nbsp;Huojie Yao ,&nbsp;Xiaomei Wu ,&nbsp;Guang Yang ,&nbsp;Qinli Wan ,&nbsp;Chunxia Jing","doi":"10.1016/j.heha.2025.100152","DOIUrl":"10.1016/j.heha.2025.100152","url":null,"abstract":"<div><div>Aging presents a significant global public health challenge, raising concerns about environmental factors. However, evidence linking multiple endocrine-disrupting chemicals (EDCs) to aging and their mechanisms is limited. This study explored the link between ten phthalates, four phenols, and two pesticides and biological senescence, along with oxidative stress's regulatory role. This cross-sectional study analyzed data from the National Health and Nutrition Examination Surveys (2005-2016) with 2668 participants and sixteen chemicals. It used multiple linear regression, Bayesian kernel machine regression (BKMR), and quantile g-computation (QGC) to explore the relationships between EDCs and phenotypic aging, as well as the mediating effects of oxidative stress. Multiple linear regression indicated that MCNP, MECPP, MEHHP, and MEOHP were linked to decreased phenotypic age acceleration (PAA). BKMR analysis showed that phthalates significantly impacted both the total population and men, with group PIP values of 0.6335 and 0.8546, respectively. QGC results confirmed negative confounding effects (Estimation [95 % CI]: -0.79 [-1.31, -0.27] for the total population; -0.89 [-1.65, -0.13] for men). Both models identified MECCP and BP3 as key contributors. Mediation analyses revealed that bilirubin and iron mediated the relationship between the chemical mixture and PAA, with proportions of -24.86 % and -21.06 %, respectively.Our findings suggest that exposure to EDCs, both individually and in combination, is linked to slowed aging, particularly with MECCP and BP3. Additional laboratory and multicenter studies are needed to validate these results.</div></div>","PeriodicalId":73269,"journal":{"name":"Hygiene and environmental health advances","volume":"16 ","pages":"Article 100152"},"PeriodicalIF":2.7,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145221313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the longitudinal impact of environmental chemical mixtures on children’s neurodevelopment: A Bayesian approach","authors":"Wei Jia ,&nbsp;Aimin Chen ,&nbsp;Kimberly Yolton ,&nbsp;Yingying Xu ,&nbsp;He Lili ,&nbsp;Roman A. Jandarov","doi":"10.1016/j.heha.2025.100146","DOIUrl":"10.1016/j.heha.2025.100146","url":null,"abstract":"<div><div>This manuscript presents a novel Bayesian varying coefficient quantile regression (BVCQR) model designed to assess the longitudinal effects of chemical exposure mixtures on children’s neurodevelopment. Recognizing the complexity and high-dimensionality of environmental exposures, the proposed approach addresses critical gaps in existing research by offering a method that can manage the sparsity of data and provide interpretable results. The proposed BVCQR model estimates the effects of mixtures on neurodevelopmental outcomes at specific ages, leveraging a horseshoe prior for sparsity and utilizing a Bayesian method for uncertainty quantification. Our simulations demonstrate the model’s robustness and effectiveness in handling high-dimensional data, offering significant improvements over traditional models. The model’s application to the Health Outcomes and Measures of the Environment (HOME) Study further illustrates its utility in identifying significant chemical exposures affecting children’s growth and development. The findings underscore the potential of BVCQR in environmental health research, providing a sophisticated tool for analyzing the longitudinal impact of complex chemical mixtures, with implications for future studies aimed at understanding and mitigating environmental risks to child health.</div></div>","PeriodicalId":73269,"journal":{"name":"Hygiene and environmental health advances","volume":"16 ","pages":"Article 100146"},"PeriodicalIF":2.7,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Toxicology research on the effects of environmental pollutants on the retina: A review","authors":"Tiantian Chen ,&nbsp;Wei Zhang ,&nbsp;Yifan Li ,&nbsp;Jin Zhou ,&nbsp;Shu Guo","doi":"10.1016/j.heha.2025.100143","DOIUrl":"10.1016/j.heha.2025.100143","url":null,"abstract":"<div><h3>Background</h3><div>As the key sensory tissue in the eye, the retina is vulnerable to environmental pollutants, with laboratory studies demonstrating their potential to disrupt retinal structure and function. To comprehensively understand the toxic effects and potential mechanisms of pollutants, this review studied the effects of major environmental pollutants, including heavy metals (cadmium, mercury, lead), organic compounds (bisphenol compounds, polychlorinated biphenyls, triclosan, chlorpyrifos), and microplastics, on the structure and function of the retina.</div></div><div><h3>Methods</h3><div>Using PubMed, Web of Science, and CNKI databases, search for keywords such as \"retina,\" \"toxicity,\" \"environmental pollutants,\" \"oxidative stress,\" \"cell apoptosis,\" \"visual function,\" and their combinations. Include original research and reviews evaluating the retinal toxicity of specific environmental pollutants, rigorously screen literature for in-depth analysis.</div></div><div><h3>Results</h3><div>Comprehensive analysis confirms that target environmental pollutants can induce significant retinal toxicity effects, including retinal developmental disorders, tissue structure damage, loss of photoreceptor cell specificity, and ultimately leading to visual dysfunction and visual related behavioral abnormalities.</div></div><div><h3>Conclusion</h3><div>This review integrates mechanistic insights from experimental toxicology research, providing a preclinical framework for understanding pollutant induced retinal damage and laying an important foundation for developing protective strategies against environmental retinal damage.</div></div>","PeriodicalId":73269,"journal":{"name":"Hygiene and environmental health advances","volume":"15 ","pages":"Article 100143"},"PeriodicalIF":2.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144921300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Climate changes and cancer risk: Key factors and emerging health threats","authors":"Marina Rayciki Sotomayor ,&nbsp;Aline Graciele Henriques Campos ,&nbsp;Altair Rodrigues Pires de Paula Filho ,&nbsp;Ana Carolina Aredes Goulart ,&nbsp;Beatriz Geovana Leite Vacario ,&nbsp;Julia Fernandes Gois Orrutéa ,&nbsp;Juliana Maria Bitencourt de Morais Valentim ,&nbsp;Tatiane Renata Fagundes ,&nbsp;Shaiane Carla Gaboardi ,&nbsp;Carolina Panis","doi":"10.1016/j.heha.2025.100145","DOIUrl":"10.1016/j.heha.2025.100145","url":null,"abstract":"<div><div>Climate change, driven by global warming and environmental degradation, has far-reaching implications for human health, including its potential role in cancer incidence. Rising temperatures, increased ultraviolet (UV) radiation, and changes in air quality are linked to various cancer risks. disruptions in agricultural practices and food security can influence cancer risk through changes in diet and exposure to carcinogenic compounds such as pesticides. Water contamination due to flooding and chemical runoffs may also increase exposure to carcinogens. Vulnerable populations, particularly those in lower-income regions, are at heightened risk, as they often lack access to healthcare and preventive measures. In this context, this review addresses the relationship between climate changes impact and cancer risk, discussing how these events can increase cancer development.</div></div>","PeriodicalId":73269,"journal":{"name":"Hygiene and environmental health advances","volume":"16 ","pages":"Article 100145"},"PeriodicalIF":2.7,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145011260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unseasonal extreme cold weather, ultrafine particles, and diabetes hospitalizations: an unexpected time window for intervention","authors":"Donghong Gao ,&nbsp;Samantha Friedman ,&nbsp;Akiko S. Hosler ,&nbsp;Scott Sheridan ,&nbsp;Wangjian Zhang ,&nbsp;Fangqun Yu ,&nbsp;Gan Luo ,&nbsp;Shao Lin","doi":"10.1016/j.heha.2025.100140","DOIUrl":"10.1016/j.heha.2025.100140","url":null,"abstract":"<div><h3>Background</h3><div>Although the associations between ambient heat and diabetes have been assessed, the odds of ambient extreme cold exposure (ECE) or ultrafine particles (UFP) on diabetes admissions are understudied.</div></div><div><h3>Objectives</h3><div>We assessed the impacts of ECE on diabetes hospitalization and evaluated the modifications of demographics, comorbidities, and UFP on ECEdiabetes associations.</div></div><div><h3>Methods</h3><div>A time-stratified case-crossover study was conducted by using mandatory New York State (NYS) admission data (principal diagnosis, 2013–2020) and temperature and simulated UPF data from NYS Mesonet and a global chemistry transport model, respectively. We defined ECE as &lt;5th percentile of daily mean temperature and UFP-high as &gt;50th percentile of the daily mean UFP. After adjusting for air pollutants, humidity, and holidays, we conducted conditional logistic regressions to investigate ECE-diabetes associations, additive and multiplicative interactions between UFP, demographics/comorbidities, and ECE.</div></div><div><h3>Results</h3><div>Diabetes admissions associated with ECE were significantly elevated in winter months (ranges of odds ratios (ORs): 1.099–1.104, <em>P</em> &lt; 0.05 in January and February) but the associations increased more consistently across multiple lag days in March (ranges of ORs: 1.068–1.129, <em>P</em> &lt; 0.05). ECE-diabetes associations were significant among patients with peripheral circulatory complications and hyperglycemia compared to those without these complications. UFP-diabetes associations were significant in November (OR: 1.052, 95 % confidence interval (CI): 1.012–1.093) and December (OR: 1.045, 95 % CI: 1.003–1.088). Additionally, ECE-UFP interactions on diabetes were significant at both additive (95 % CI &gt;0 for the attributable proportion to interactions and relative excess risk index) and multiplicative (<em>P</em> &lt; 0.05 for product terms) scales. Furthermore, females, older adults, urban residents, and patients with multiple comorbidities were more vulnerable to ECE than other groups.</div></div><div><h3>Conclusions</h3><div>ECE-diabetes associations were significant in winter months, but the increased associations occurred more persistently in March. While synergistic and additive interactions between ECE and UFP on diabetes were found, ECE-diabetes ssociations were also modified by demographics and comorbidities.</div></div>","PeriodicalId":73269,"journal":{"name":"Hygiene and environmental health advances","volume":"15 ","pages":"Article 100140"},"PeriodicalIF":2.7,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144860581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}