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. 2024 Nov 12:17:5151-5161.
doi: 10.2147/JMDH.S481288. eCollection 2024.

Phthalate Metabolites Were Related to the Risk of High-Frequency Hearing Loss: A Cross-Sectional Study of National Health and Nutrition Examination Survey

Li-Mei You #  1 , De-Chang Zhang #  1 , Chang-Shui Lin  1 , Qiong Lan  1
Affiliations

Phthalate Metabolites Were Related to the Risk of High-Frequency Hearing Loss: A Cross-Sectional Study of National Health and Nutrition Examination Survey

Li-Mei You et al. J Multidiscip Healthc. .

Abstract

Background: Phthalate metabolites are pervasive in the environment and linked to various health issues. This study aimed to investigate the relationship between phthalate metabolites and hearing loss.

Methods: We conducted a cross-sectional study with 1713 participants based on the National Health and Nutrition Examination Survey 2015-2018. Participants were defined as speech-frequency hearing loss (SFHL) or high-frequency hearing loss (HFHL). We analyzed the baseline characteristics of participants and assessed the detection rates of phthalate metabolites in samples. Phthalate metabolites with detection rates of >85% were enrolled. Then, restricted cubic spline and multivariable logistic regression analyses were conducted to explore the association of phthalate metabolites with hearing loss. Multi-model analysis was employed to select an optimal predictive model for HFHL based on phthalate metabolites and clinical factors.

Results: Among participants, 24.518% had SFHL and 41.998% had HFHL, associated with older age, higher BMI, male, non-Hispanic white, lower physical activity levels, higher exposure to work noise, hypertension, and diabetes. Monobenzyl phthalate (MBZP) showed a positive linear association with both SFHL and HFHL. Multivariable logistic regression revealed MBZP as a significant risk factor for HFHL (odds ratio=1.339, 95% confidence interval, 1.053-1.707). According to the area under curve (AUC) values, the logistic regression model had the best diagnostic performance of HFHL, with the highest AUC values of 0.865 in the test set. In the model, gender, diabetes, and MBZP were the top predictors of HFHL.

Conclusion: The study identified a significant association between MBZP exposure and HFHL, highlighting the need to reduce phthalate exposure.

Keywords: cross-sectional; hearing loss; machine learning models; monobenzyl phthalate; phthalate metabolites.

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Conflict of interest statement

Li-mei You and De-Chang Zhang contributed equally to this work, and should be regarded as co-first authors. The authors report no conflict of interest.

Figures

Figure 1
Figure 1
Restricted cubic spline analysis revealed the association of MBZP and MEP with hearing loss. The linear association of MBZP with SFHL (A) and HFHL (B). The linear association of MEP with SFHL (C) and HFHL (D).
Figure 2
Figure 2
Optimal selection of BMZP-clinical model and feature importance rank. The predictive performance of the MBZP-clinical model for high-frequency hearing loss in the training set (A) and test set (B) to identify logistic regression as the optimal model. (C) The importance of the features in the logistic regression model.
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