Associations with Blood Lead and Urinary Cadmium Concentrations in Relation to Mortality in the US Population: A Causal Survival Analysis with G-Computation

Using the parametric g-formula, we estimated the 27-year risk of all-cause and specific causes of mortality under different potential interventions for blood lead (BLLs) and urinary cadmium (UCd) levels. We used data on 14,311 adults aged ≥20 years enrolled in the NHANES-III between 1988 and 1994 an...

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Bibliographic Details
Published in:Toxics (Basel) 2023-01, Vol.11 (2), p.133
Main Authors: Laouali, Nasser, Benmarhnia, Tarik, Lanphear, Bruce P, Oulhote, Youssef
Format: Article
Language:English
Subjects:
Blood
Blood levels
Cadmium
Cancer
cardiovascular
Cardiovascular disease
Cardiovascular diseases
Creatinine
Death
Disease control
Environmental aspects
epidemiology
Fatalities
Health aspects
Lead
Life Sciences
Measurement
Medical laboratories
metals
Methods
Mortality
NHANES
Nutrition research
Patient outcomes
Population
Regression analysis
Regression models
Risk
Risk factors
Survival analysis
Urine
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Summary:Using the parametric g-formula, we estimated the 27-year risk of all-cause and specific causes of mortality under different potential interventions for blood lead (BLLs) and urinary cadmium (UCd) levels. We used data on 14,311 adults aged ≥20 years enrolled in the NHANES-III between 1988 and 1994 and followed up through 31 Dec 31 2015. Time and cause of death were determined from the National Death Index records. We used the parametric g-formula with pooled logistic regression models to estimate the relative and absolute risk of all-cause, cardiovascular, and cancer mortality under different potential threshold interventions for BLLs and UCd concentrations. Median follow-up was 22.5 years. A total of 5167 (36%) participants died by the end of the study, including 1550 from cardiovascular diseases and 1135 from cancer. Increases in BLLs and creatinine-corrected UCd levels from the 5th to the 95th percentiles were associated with risk differences of 4.17% (1.54 to 8.77) and 6.22% (4.51 to 12.00) for all-cause mortality, 1.52% (0.09 to 3.74) and 1.06% (-0.57 to 3.50) for cardiovascular disease mortality, and 1.32% (-0.09 to 3.67) and 0.64% (-0.98 to 2.80) for cancer mortality, respectively. Interventions to reduce historical exposures to lead and cadmium may have prevented premature deaths, especially from cardiovascular disease.
ISSN:2305-6304
2305-6304
DOI:10.3390/toxics11020133