Ethylene Oxide Exposure in U.S. Populations Residing Near Sterilization and Other Industrial Facilities: Context Based on Endogenous and Total Equivalent Concentration Exposures

Ethylene Oxide in Southeastern Louisiana's Petrochemical Corridor: High Spatial Resolution Mobile Monitoring during HAP-MAP

Ethylene oxide ("EtO") is an industrially made volatile organic compound and a known human carcinogen. There are few reliable reports of ambient EtO concentrations around production and end-use facilities, however, despite major exposure concerns. We present in situ, fast (1 Hz), sensitive EtO measurements made during February 2023 across the southeastern Louisiana industrial corridor. We aggregated mobile data at 500 m spatial resolution and reported average mixing ratios for 75 km of the corridor. Mean and median aggregated values were 31.4 and 23.3 ppt, respectively, and a majority (75%) of 500 m grid cells were above 10.9 ppt, the lifetime exposure concentration corresponding to 100-in-one million excess cancer risk (1 × 10-4). A small subset (3.3%) were above 109 ppt (1000-in-one million cancer risk, 1 × 10-3); these tended to be near EtO-emitting facilities, though we observed plumes over 10 km from the nearest facilities. Many plumes were highly correlated with other measured gases, indicating potential emission sources, and a subset was measured simultaneously with a second commercial analyzer, showing good agreement. We estimated EtO for 13 census tracts, all of which were higher than EPA estimates (median difference of 21.3 ppt). Our findings provide important information about EtO concentrations and potential exposure risks in a key industrial region and advance the application of EtO analytical methods for ambient sampling and mobile monitoring for air toxics.

Association between blood ethylene oxide levels and the prevalence of periodontitis: evidence from NHANES 2013-2014

BACKGROUND

The study aimed to establish a link between blood ethylene oxide (EO) levels and periodontitis, given the growing concern about EO's detrimental health effects.

MATERIALS AND METHODS

The study included 1006 adults from the 2013-2014 National Health and Nutrition Examination Survey (NHANES) dataset. We assessed periodontitis prevalence across groups, used weighted binary logistic regression and restricted cubic spline fitting for HbEO-periodontitis association, and employed Receiver Operating Characteristic (ROC) curves for prediction.

RESULTS

In the periodontitis group, HbEO levels were significantly higher (40.57 vs. 28.87 pmol/g Hb, P < 0.001). The highest HbEO quartile showed increased periodontitis risk (OR = 2.88, 95% CI: 1.31, 6.31, P = 0.01). A "J"-shaped nonlinear HbEO-periodontitis relationship existed (NL-P value = 0.0116), with an inflection point at ln-HbEO = 2.96 (EO = 19.30 pmol/g Hb). Beyond this, ln-HbEO correlated with higher periodontitis risk. A predictive model incorporating sex, age, education, poverty income ratio, alcohol consumption, and HbEO had 69.9% sensitivity and 69.2% specificity. The model achieved an area under the ROC curve of 0.761.

CONCLUSIONS

These findings suggest a correlation between HbEO levels and an increased susceptibility to periodontitis.

Suitability of new and existing ambient ethylene oxide measurement techniques for cancer inhalation risk assessment

Ethylene oxide (EtO) is an industrial gas that was recently reassessed to pose significant additional cancer risk at low ambient concentrations. The objective of this study is to evaluate the capabilities of existing and novel techniques to measure ambient EtO at concentrations relevant for assessing cancer risk. We present the first comparison of background ambient EtO measurements between the standard offline TO-15 techniques and two new cavity ringdown spectroscopy (CRDS) instruments, the Picarro G2920 Ethylene Oxide Gas Analyzer and the Entanglement Technologies AROMA-ETO, at a site in Atlanta, GA. Then, we analyzed background EtO measured at EPA NATTS sites across the US. Finally, we used TO-15 measurement data to assess EtO cancer risk at three near-source sites. We find that the TO-15 method has low precision for collocated samples (NME ranges from 24% to 63%), and measurements made with TO-15 pressurized samplers are biased 27% low compared to those from TO-15 passive samplers. Both CRDS methods are biased low compared to TO-15 methods (88% and 31% low bias for Picarro and AROMA, respectively), and TO-15 methods observe a seasonal peak during summer (June to September) whereas Picarro observes no seasonal trend. From our near-source assessment, we find only one site with notable elevation in cancer risk prior to EtO controls installation. Our results suggest that measurement techniques need further development to accurately assess near-source EtO cancer risk. Because different techniques measure distinct EtO trends, EtO cancer risk studies that rely on current measurement capabilities should subtract simultaneous background observations from near-source observations measured by the same method to account for these real or artificial background trends.

Integrative literature review: Ethylene oxide exposure signs and symptoms

BACKGROUND

Although ethylene oxide (EtO) gas is designated as a human carcinogen, extant literature reports mixed findings on the health effects of exposure. The disparate findings may reflect industry bias as many studies were funded by a large chemical industry lobby.

OBJECTIVE

To conduct an integrative review of studies free from industry bias to facilitate compilation of a comprehensive list of reported signs and symptoms of EtO exposure.

METHODS

We reviewed 1887 papers of which 42 articles met inclusion criteria. The authors conducted this review in accordance with PRISMA guidelines. The presence of bias was assessed using Joanna Briggs Institute checklists.

RESULTS

Non-industry biased literature confirmed serious adverse health effects associated with EtO exposure at the occupational, hospital, and community level. EtO represents a carcinogen, neurotoxin, and respiratory irritant.

CONCLUSION

After removal of industry-biased studies, EtO was unequivocally found to pose a threat to human health. There remains a gap in the number of studies examining community-level exposure, which is essential to understanding the impact of EtO. Given that EtO-emitting facilities are concentrated in diverse and disadvantaged communities, further study of EtO exposure health effects is warranted to inform public policy on toxic air emissions.

Assessment of Chemical Facility Ethylene Oxide Emissions Using Mobile and Multipoint Monitoring

Ethylene oxide (EtO) is a hazardous air pollutant that can be emitted from a variety of difficult to measure industrial sources, such as fugitive leaks, wastewater handling, and episodic releases. Emerging next generation emission measurement (NGEM) approaches capable of time-resolved, low parts per billion by volume (ppbv) method detection limits (MDLs) can help facilities understand and reduce EtO and other air pollutant emissions from these sources yielding a range of environmental and public health benefits. In October 2021, a first of its kind 4-day observational study was conducted at an EtO chemical facility in the midwestern United States. The study had dual objectives to both improve understanding of EtO emission sources within the facility and advance NGEM methods. Using cavity ring-down spectroscopy (CRDS) instruments, a combination of mobile surveys and stationary multipoint process unit monitoring assessed EtO concentrations in and near facility operations, while testing and comparing measurement methods. The study concluded that four main areas of EtO source emissions existed within the facility, each possessing unique emission characteristics. Episodic EtO emissions from supply railcar switchovers and batch reactor washouts, lasting seconds to minutes in duration, produced EtO concentrations exceeding 500 ppbv inside the process unit in some cases. In one instance, EtO at ~30 ppbv was briefly observed hundreds of meters from the process unit. Lower level but more sustained EtO concentrations were observed near an EtO transfer pump and wastewater tank outfall and drain system. Overall, 4.6% of mobile survey data were above the 1.2 ppbv mobile test MDL while the nine stationary sampling locations ranged from 17.7% to 82.8% of data above the 1.0 ppbv multipoint test MDL. This paper describes the EtO emissions observed in and near the four defined source areas within the facility and provides details of the NGEM method development advances accomplished as part of the study.

Systematic review of the scientific evidence on ethylene oxide as a human carcinogen

Ethylene oxide is a highly reactive chemical primarily used as an intermediate in chemical production and as a sterilant of medical equipment and food products; it also is produced endogenously as a result of physiological processes. We conducted a systematic review of the potential carcinogenicity of inhaled ethylene oxide in humans using methods that adhere to PRIMSA guidelines and that incorporate aspects from the Institute of Medicine (IOM) (now the National Academy of Medicine) as well as several US Environmental Protection Agency (EPA) frameworks for systematic reviews. After a comprehensive literature search and selection process, study quality was evaluated following a method adapted from the EPA Toxic Substances Control Act (TSCA) framework. The literature screening and selection process identified 24 primary studies in animals or humans and more than 50 mechanistic studies. Integrating epidemiological, animal, and mechanistic literature on ethylene oxide and cancer according to the IOM framework yielded classifications of suggestive evidence of no association between ethylene oxide and stomach cancer, breast cancer and lymphohematopoietic malignancies at human relevant exposures. However, we acknowledge that there is additional uncertainty in the classification for lymphohematopoietic malignancies owing to a paucity of evidence for specific types of these tumors, each of which is a distinct disease entity of possibly unique etiology.

Monitored and Modeled Ambient Air Concentrations of Ethylene Oxide: Contextualizing Health Risk for Potentially Exposed Populations in Georgia

Recent studies have monitored and modeled long-term ambient air concentrations of ethylene oxide (EO) around emitting facilities in Georgia with the intent of informing risk management of potentially exposed nearby residential populations. Providing health context for these data is challenging because the U.S. Environmental Protection Agency’s risk-specific concentrations lack practical utility in distinguishing a health significant increase in exposure. This study analyzes EO data for eight emitting facilities, using a previously published alternative exposure metric, the total equivalent concentration, which is based on U.S. Centers for Disease Control biomarker data for the non-smoking U.S. population. Mean concentrations for monitoring sites were compared to mean background concentrations to assess whether emissions contribute significantly to environmental concentrations. To assess the health significance of potential exposure at nearby residential locations, the 50th percentile concentration was added to the 50th percentile endogenous equivalent concentration and compared to the total equivalent concentration distribution for the non-smoking U.S. population. The findings demonstrate that impacts from nearby emission sources are small compared to mean background concentrations at nearby locations, and the total equivalent concentrations for exposed populations are generally indistinguishable from that of the 50th percentile for the non-smoking U.S. population.