Association between serum brominated flame retardant exposure and self-reported stroke: an analysis based on NHANES data

Brominated flame retardants (BFRs) are persistent environmental pollutants with known neurotoxic and endocrine-disrupting properties, yet their associations with stroke risk remain poorly understood. This study aimed to investigate the associations between serum BFR concentrations and stroke risk in U.S. adults. Using data from the National Health and Nutrition Examination Survey 2013–2014, we investigated the associations between serum concentrations of 12 BFRs and self-reported stroke among U.S. adults. Weighted logistic regression, restricted cubic spline models, Bayesian kernel machine regression, and weighted quantile sum regression were applied to evaluate single and mixed exposure effects. In fully adjusted models, PBDE−47, PBDE−85, PBDE−99, PBDE−100, and PBDE−154 showed nominally significant positive associations with self-reported stroke. Nonlinear dose–response relationships were observed for PBDE−47, − 85, and − 99. Mixture analyses demonstrated a significant combined effect of BFRs on stroke risk, particularly when overall exposure exceeded the 55th percentile. Stronger associations were observed among women, obese individuals, physically inactive participants, and those with hypertension. BFR exposure is associated with elevated stroke risk in the general population. These findings provide novel epidemiological evidence linking environmental pollutants to cerebrovascular disease and highlight vulnerable subgroups for targeted prevention.