Human epididymis protein 4: Analysis of national health and nutrition examination survey data

•To examine the effect of factors on HE4 values in a national representative sample of women in the United States.•Elevated HE4 levels were associated with postmenopausal status, endometriosis, nicotine exposure, and poor renal function.•Decreased HE4 levels was associated with use of oral contraceptives.•This study of samples from 98.5 million non-institutionalized women in the United States confirms variables that affect HE4 levels. Human epididymis protein 4 (HE4) is a tumor marker overexpressed in ovarian cancer and is commonly utilized to aid with diagnosis of an adnexal mass. HE4 levels vary based on pregnancy, age, menopausal status, and tobacco use. The objective of this study was to evaluate population-based data to examine factors that affect HE4 among adult women in the United States and stratify levels of HE4 by demographic and gynecologic factors. A retrospective analysis was conducted using data from 2,480 women aged 20 + who participated in the National Health and Nutrition Examination Survey (2001–2002). From these cross-sectional data, serum HE4 and cotinine, a marker of tobacco exposure, were combined with demographic and interview data. Estimated glomerular filtration rates (eGFR) were based on serum creatinine, age, sex, and race. Other variables of interest included menopausal status, pregnancy, and various gynecologic factors. Summary HE4 data are provided as geometric means with associated 95 % confidence intervals. HE4 levels were independently associated with age, renal function, and nicotine use, all p