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Zhou YH, Bai YJ, Zhao XY. Combined exposure to multiple metals on abdominal aortic calcification: results from the NHANES study. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2024; 31:24282-24301. [PMID: 38438641 DOI: 10.1007/s11356-024-32745-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 02/28/2024] [Indexed: 03/06/2024]
Abstract
Exposure to metals increases the risk of many diseases and has become a public health concern. However, few studies have focused on the effect of metal on abdominal aortic calcification (AAC), especially the combined effects of metal mixtures. In this study, we aim to investigate the combined effect of metals on AAC risk and determine the key components in the multiple metals. We tried to investigate the relationship between multiple metal exposure and AAC risk. Fourteen urinary metals were analyzed with five statistical models as follows: generalized linear regression, weighted quantile sum regression (WQS), quantile g-computation (Qgcomp), and Bayesian kernel machine regression (BKMR) models. A total of 838 participants were involved, of whom 241 (28.8%) had AAC. After adjusting for covariates, in multiple metal exposure logistic regression, cadmium (Cd) (OR = 1.364, 95% CI = 1.035-1.797) was positively associated with AAC risk, while cobalt (Co) (OR = 0.631, 95% CI = 0.438-0.908) was negatively associated with AAC risk. A significant positive effect between multiple metal exposure and AAC risk was observed in WQS (OR = 2.090; 95% CI = 1.280-3.420, P < 0.01), Qgcomp (OR = 1.522, 95% CI = 1.012-2.290, P < 0.05), and BKMR models. It was found that the positive association may be driven primarily by Cd, lead (Pb), uranium (U), and tungsten (W). Subgroups analysis showed the association was more significant in participants with BMI ≥ 25 kg/m2, abdominal obesity, drinking, and smoking. Our study shows that exposure to multiple metals increases the risk of AAC in adults aged ≥ 40 years in the USA and that Cd, Pb, U, and W are the main contributors. The association is stronger in participants who are obese, smoker, or drinker.
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Affiliation(s)
- Yuan-Hang Zhou
- Department of Cardiology, Cardiovascular Center, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
- Henan Key Laboratory of Hereditary Cardiovascular Diseases, Zhengzhou, 450052, China
| | - Yu-Jie Bai
- Department of Nuclear Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Xiao-Yan Zhao
- Department of Cardiology, Cardiovascular Center, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
- Henan Key Laboratory of Hereditary Cardiovascular Diseases, Zhengzhou, 450052, China.
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Mayer M, Feng T, Sukut S, Wiebe S, Parker S, Blakley B, Koehncke N. Blood and Hand Surface Lead in Veterinary Workers Using Lead Shielding During Diagnostic Radiography. J Occup Environ Med 2023; 65:794-797. [PMID: 37311074 DOI: 10.1097/jom.0000000000002908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVES The objectives are to compare lead blood concentrations in veterinary workers using lead shielding with concentrations in a control population, to measure hand surface lead before and after use of shielding, and to compare hand surface lead with and without the use of disposable gloves worn under hand shielding. METHODS Blood and hand wipe samples were analyzed for lead using inductively coupled plasma mass spectrometry. RESULTS There was no difference in blood lead between exposed and control groups. After lead glove use, 69% (18/26) of hand surface lead samples from workers not using disposable gloves were greater than 500 μg, 42% (11/26) were greater than 1000 μg, and 12% (3/26) were greater than 2000 μg. CONCLUSIONS If lead shielding use is unavoidable, disposable gloves should be worn, and skin should be decontaminated after use.
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Affiliation(s)
- Monique Mayer
- From the Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Canada (M.M., S.S.); Department of Medicine, College of Medicine, Saskatoon, Canada (T.F., N.K.); Department of Medical Imaging, College of Medicine, Saskatoon, Canada (S.W.); Department of Large Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Canada (S.P.); and Department of Veterinary Biomedical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Canada (B.B.)
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Mohammadi M, Ariafar S, Talebi-Ghane E, Afzali S. Comparative efficacy of silibinin and nano-silibinin on lead poisoning in Male Wistar rats. Toxicology 2022; 475:153242. [PMID: 35752206 DOI: 10.1016/j.tox.2022.153242] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/16/2022] [Accepted: 06/17/2022] [Indexed: 11/17/2022]
Abstract
Lead (Pb) is an environmental neurotoxin that can lead to toxicity. It has shown that tissues can be exposed to oxidative stress in lead poisoning. Since silymarin is a natural agent with antioxidant effects, this study aimed to investigate the antioxidant and chelation effects of silibinin and nano-silibinin on the oxidative stress status in lead-poisoned rats. Sixty male Wistar rats randomly divided into ten groups (n = 6). Control and Pb groups treated with or without silibinin and nano-silibinin for six days. Following measuring of weight and blood lead levels, biochemical antioxidant parameters evaluated. Finally, a histopathological examination of the liver performed. In this experiment, silibinin and more efficiently nano-silibinin prevented weight loss and blood lead level elevation induced by lead. Also, they increased the attenuated levels of superoxide dismutase (SOD) activity, catalase (CAT), total thiol molecules (TTM), glutathione (GSH), and total antioxidant capacity (TAC). Lead-induced elevation of lipid peroxidation products (MDA) and nitric oxide (NO) normalized to the standard level in silibinin and especially nano-silibinin groups. These data suggested that silibinin and especially nano-silibinin can decrease blood lead levels and prevent weight loss and oxidative stress in the lead-poisoned rat's model.
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Affiliation(s)
- Mojdeh Mohammadi
- Department of Pharmacology & Toxicology, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran; Behavioral Disorders and Substance Abuse Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Saba Ariafar
- Department of Pharmacology & Toxicology, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran; Behavioral Disorders and Substance Abuse Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Elaheh Talebi-Ghane
- Department of Biostatistics, Hamadan University of Medical Sciences, Hamadan, Iran; Modeling of Non-Communicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran; Behavioral Disorders and Substance Abuse Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Saeed Afzali
- Department of Forensic Medicine and Clinical Toxicology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran; Behavioral Disorders and Substance Abuse Research Center, Hamadan University of Medical Sciences, Hamadan, Iran.
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Bao QJ, Zhao K, Guo Y, Wu XT, Yang JC, Yang MF. Environmental toxic metal contaminants and risk of stroke: a systematic review and meta-analysis. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:32545-32565. [PMID: 35190994 DOI: 10.1007/s11356-022-18866-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 01/21/2022] [Indexed: 06/14/2023]
Abstract
The relationship between toxic metals in the environment and clinical stroke risk remains unclear, although their role as immunotoxicants and carcinogens has been well established. We conducted a systematic review of the relationship between five metals (arsenic, mercury, copper, cadmium, and lead) and stroke. First, we comprehensively searched 3 databases (Pubmed, EMBASE, and Cochrane) from inception until June 2021. Random-effects meta-analyses, pooled relative risks (RR) and 95% confidence intervals (CI) were applied to evaluate the effect value. We finally identified 38 studies involving 642,014 non-overlapping participants. Comparing the highest vs. lowest baseline levels, chronic exposure to lead (RR = 1.07; 95%CI,1.00-1.14), cadmium (RR = 1.30; 95%CI,1.13-1.48), and copper (RR = 1.19; 95%CI,1.04-1.36) were significantly associated with stroke risks. However, the other two metals (arsenic and mercury) had less effect on stroke risk. Further analysis indicated that the association was likely in a metal dose-dependent manner. The results may further support the possibility that environmental toxic metal contaminants in recent years are associated with the increased risk of stroke.
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Affiliation(s)
- Qiang-Ji Bao
- Graduate School, Qinghai University, Xining, 810016, Qinghai, China
| | - Kai Zhao
- Graduate School, Qinghai University, Xining, 810016, Qinghai, China
| | - Yu Guo
- Graduate School, Qinghai University, Xining, 810016, Qinghai, China
| | - Xin-Ting Wu
- Graduate School, Qinghai University, Xining, 810016, Qinghai, China
| | - Jin-Cai Yang
- Graduate School, Qinghai University, Xining, 810016, Qinghai, China
| | - Ming-Fei Yang
- Department of Neurosurgery, Qinghai Provincial People's Hospital, Xining, 810007, Qinghai, China.
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Mayer MN, Sukut SL, Blakley B, Waldner CL, Adesina K, Belotta AF, Koehncke NK. Workers should take steps to mitigate surface lead exposure when using lead-containing personal protective equipment. Vet Radiol Ultrasound 2021; 63:23-29. [PMID: 34637582 DOI: 10.1111/vru.13032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/14/2021] [Accepted: 08/22/2021] [Indexed: 11/29/2022] Open
Abstract
Veterinary workers use lead shielding for protection against harm from ionizing radiation during diagnostic imaging. Surface lead on shielding has been reported as a potential exposure hazard. The purpose of this prospective, analytical, descriptive study was to measure surface lead on lead-containing shielding in the field service and small animal radiology areas of a veterinary teaching hospital, and to examine potential risk factors for surface lead. Surface lead on a convenience sample of 54 lead shielding items was measured in a commercial laboratory using inductively coupled plasma mass spectrometry. The median and range of surface lead for aprons, thyroid collars, and gloves were 3.6 μg/dm2 (range, 1.3-22.4 μg/dm2 ), 23.1 μg/dm2 (range, 2.6-116 μg/dm2 ), and 134 μg/dm2 (range, 1.5-155 μg/dm2 ), respectively. In the final multivariable analysis, the mean surface lead on thyroid collars and gloves was higher than on aprons (relative differences 4.8, 95% confidence interval [CI] 2.2, 10.5, P < 0.001; and 9.5, 95% CI 4.4, 20.6, P < 0.001, respectively). The mean surface lead on shielding in the worst condition was higher than on shielding in the intermediate and best conditions (P < 0.001). Lead shielding provides effective protection against the harmful effects of ionizing radiation, and shielding should always be worn during radiation exposure. Based on our findings and the common use of lead shielding in veterinary workplaces, we recommend that employers inform workers of this hazard and provide training on steps to mitigate exposure, including the use of disposable gloves when wearing lead shielding and handwashing after use.
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Affiliation(s)
- Monique N Mayer
- Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Sally L Sukut
- Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Barry Blakley
- Department of Veterinary Biomedical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Cheryl L Waldner
- Department of Large Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Kayode Adesina
- Department of Medicine, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Alexandra F Belotta
- Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Niels K Koehncke
- Department of Medicine, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
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Pietrzak S, Wójcik J, Baszuk P, Marciniak W, Wojtyś M, Dębniak T, Cybulski C, Gronwald J, Alchimowicz J, Masojć B, Waloszczyk P, Gajić D, Grodzki T, Jakubowska A, Scott RJ, Lubiński J, Lener MR. Influence of the Levels of Arsenic, Cadmium, Mercury and Lead on Overall Survival in Lung Cancer. Biomolecules 2021; 11:biom11081160. [PMID: 34439826 PMCID: PMC8392714 DOI: 10.3390/biom11081160] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/30/2021] [Accepted: 08/03/2021] [Indexed: 12/24/2022] Open
Abstract
The effects of heavy metals on cancer risk have been widely studied in recent decades, but there is limited data on the effects of these elements on cancer survival. In this research, we examined whether blood concentrations of the heavy metals arsenic, cadmium, mercury and lead were associated with the overall survival of lung cancer patients. The study group consisted of 336 patients with lung cancer who were prospectively observed. Blood concentrations of heavy metals were measured to study the relationship between their levels and overall survival using Cox proportional hazards analysis. The hazard ratio of death from all causes was 0.99 (p = 0.94) for arsenic, 1.37 (p = 0.15) for cadmium, 1.55 (p = 0.04) for mercury, and 1.18 (p = 0.47) for lead in patients from the lowest concentration quartile, compared with those in the highest quartile. Among the patients with stage IA disease, this relationship was statistically significant (HR = 7.36; p < 0.01) for cadmium levels in the highest quartile (>1.97–7.77 µg/L) compared to quartile I (0.23–0.57 µg/L, reference). This study revealed that low blood cadmium levels <1.47 µg/L are probably associated with improved overall survival in treated patients with stage IA disease.
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Affiliation(s)
- Sandra Pietrzak
- International Hereditary Cancer Center, Department of Genetics and Pathology, Pomeranian Medical University in Szczecin, ul. Unii Lubelskiej 1, 71-252 Szczecin, Poland; (P.B.); (T.D.); (C.C.); (J.G.); (A.J.); (J.L.); (M.R.L.)
- Correspondence: ; Tel.: +48-91-441-72-50
| | - Janusz Wójcik
- Department of Thoracic Surgery and Transplantation, Pomeranian Medical University in Szczecin, ul. A. Sokołowskiego 11, 70-891 Szczecin, Poland; (J.W.); (M.W.); (J.A.); (D.G.); (T.G.)
| | - Piotr Baszuk
- International Hereditary Cancer Center, Department of Genetics and Pathology, Pomeranian Medical University in Szczecin, ul. Unii Lubelskiej 1, 71-252 Szczecin, Poland; (P.B.); (T.D.); (C.C.); (J.G.); (A.J.); (J.L.); (M.R.L.)
| | | | - Małgorzata Wojtyś
- Department of Thoracic Surgery and Transplantation, Pomeranian Medical University in Szczecin, ul. A. Sokołowskiego 11, 70-891 Szczecin, Poland; (J.W.); (M.W.); (J.A.); (D.G.); (T.G.)
| | - Tadeusz Dębniak
- International Hereditary Cancer Center, Department of Genetics and Pathology, Pomeranian Medical University in Szczecin, ul. Unii Lubelskiej 1, 71-252 Szczecin, Poland; (P.B.); (T.D.); (C.C.); (J.G.); (A.J.); (J.L.); (M.R.L.)
| | - Cezary Cybulski
- International Hereditary Cancer Center, Department of Genetics and Pathology, Pomeranian Medical University in Szczecin, ul. Unii Lubelskiej 1, 71-252 Szczecin, Poland; (P.B.); (T.D.); (C.C.); (J.G.); (A.J.); (J.L.); (M.R.L.)
- Read-Gene, ul. Alabastrowa 8, 72-003 Grzepnica, Poland;
| | - Jacek Gronwald
- International Hereditary Cancer Center, Department of Genetics and Pathology, Pomeranian Medical University in Szczecin, ul. Unii Lubelskiej 1, 71-252 Szczecin, Poland; (P.B.); (T.D.); (C.C.); (J.G.); (A.J.); (J.L.); (M.R.L.)
- Read-Gene, ul. Alabastrowa 8, 72-003 Grzepnica, Poland;
| | - Jacek Alchimowicz
- Department of Thoracic Surgery and Transplantation, Pomeranian Medical University in Szczecin, ul. A. Sokołowskiego 11, 70-891 Szczecin, Poland; (J.W.); (M.W.); (J.A.); (D.G.); (T.G.)
| | - Bartłomiej Masojć
- Radiation Oncology Department, West Pomeranian Oncology Center, ul. Strzałkowska 22, 71-730 Szczecin, Poland;
| | - Piotr Waloszczyk
- Independent Laboratory of Pathology, Zdunomed, ul. Energetyków 2, 70-656 Szczecin, Poland;
| | - Darko Gajić
- Department of Thoracic Surgery and Transplantation, Pomeranian Medical University in Szczecin, ul. A. Sokołowskiego 11, 70-891 Szczecin, Poland; (J.W.); (M.W.); (J.A.); (D.G.); (T.G.)
| | - Tomasz Grodzki
- Department of Thoracic Surgery and Transplantation, Pomeranian Medical University in Szczecin, ul. A. Sokołowskiego 11, 70-891 Szczecin, Poland; (J.W.); (M.W.); (J.A.); (D.G.); (T.G.)
| | - Anna Jakubowska
- International Hereditary Cancer Center, Department of Genetics and Pathology, Pomeranian Medical University in Szczecin, ul. Unii Lubelskiej 1, 71-252 Szczecin, Poland; (P.B.); (T.D.); (C.C.); (J.G.); (A.J.); (J.L.); (M.R.L.)
| | - Rodney J. Scott
- Priority Research Centre for Cancer Research, Innovation and Translation, Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia;
- School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia
- Division of Molecular Medicine, Pathology North, John Hunter Hospital, New Lambton, NSW 2305, Australia
| | - Jan Lubiński
- International Hereditary Cancer Center, Department of Genetics and Pathology, Pomeranian Medical University in Szczecin, ul. Unii Lubelskiej 1, 71-252 Szczecin, Poland; (P.B.); (T.D.); (C.C.); (J.G.); (A.J.); (J.L.); (M.R.L.)
- Read-Gene, ul. Alabastrowa 8, 72-003 Grzepnica, Poland;
| | - Marcin R. Lener
- International Hereditary Cancer Center, Department of Genetics and Pathology, Pomeranian Medical University in Szczecin, ul. Unii Lubelskiej 1, 71-252 Szczecin, Poland; (P.B.); (T.D.); (C.C.); (J.G.); (A.J.); (J.L.); (M.R.L.)
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Malook K. Orange Peel Powder: A Potential Adsorbent for Pb(II) Ions Removal from Water. THEORETICAL FOUNDATIONS OF CHEMICAL ENGINEERING 2021. [DOI: 10.1134/s004057952103012x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Kim M, Yun SM, Jeong J, Jo C, Koh YH. Association between blood lead level and risk of stroke in Korean adults: a cross-sectional study in the Korea National Health and Nutrition Examination Survey 2008-2013. BMJ Open 2020; 10:e035725. [PMID: 32907895 PMCID: PMC7482501 DOI: 10.1136/bmjopen-2019-035725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Although lead is a potential risk factor for cardiovascular diseases such as stroke, research on this association in the Korean population remains limited. Therefore, we aimed to investigate the association between lead level and stroke in Korean adults. DESIGN A population-based cross-sectional study. SETTING The Korea National Health and Nutrition Examination Survey 2008-2013, which enrolled a representative sample of the Korean population. PARTICIPANTS We excluded participants younger than 20 years, missing weight data, pregnant or lactating, and missing blood lead and stroke data. A total of 11 510 participants were included in this analysis. PRIMARY AND SECONDARY OUTCOME MEASUREMENT The participants were classified by blood lead concentration into the low-level (≤2.189 µg/dL, n=5756) and high-level (>2.189 µg/dL, n=5754) groups. The main outcome, stroke, was assessed by information from physician diagnosis, prevalence of stroke or treatment for stroke. The ORs and 95% CIs were calculated to evaluate the association between blood lead level and stroke using multivariate logistic regression analysis. RESULTS Although blood lead level was not significantly associated with stroke (OR: 1.30, 95% CI: 0.66-2.58) in the multivariate-adjusted model, in individuals with hypertension, the high-level group was 2.36-fold higher odds of stroke (OR: 2.36, 95% CI: 1.02-5.44) compared to that in the low-level group. No association was observed in individuals with normotension (OR: 0.42, 95% CI: 0.13-1.38, p for interaction=0.007). CONCLUSION The association between blood lead concentration and stroke may be influenced by hypertension status. Our findings suggest the need for closer attention to lead exposure in patients with hypertension.
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Affiliation(s)
- Minkyeong Kim
- Division of Brain Diseases, Korea National Institute of Health, Cheongju, South Korea
| | - Sang-Moon Yun
- Division of Brain Diseases, Korea National Institute of Health, Cheongju, South Korea
| | - Jihyun Jeong
- Division of Brain Diseases, Korea National Institute of Health, Cheongju, South Korea
| | - Chulman Jo
- Division of Brain Diseases, Korea National Institute of Health, Cheongju, South Korea
| | - Young Ho Koh
- Division of Brain Diseases, Korea National Institute of Health, Cheongju, South Korea
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Staessen JA, Thijs L, Yang WY, Yu CG, Wei FF, Roels HA, Nawrot TS, Zhang ZY. Interpretation of Population Health Metrics: Environmental Lead Exposure as Exemplary Case. Hypertension 2020; 75:603-614. [PMID: 32008462 PMCID: PMC8032208 DOI: 10.1161/hypertensionaha.119.14217] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Our objective was to gain insight in the calculation and interpretation of population health metrics that inform disease prevention. Using as model environmental exposure to lead (ELE), a global pollutant, we assessed population health metrics derived from the Third National Health and Nutrition Examination Survey (1988 to 1994), the GBD (Global Burden of Disease Study 2010), and the Organization for Economic Co-operation and Development. In the National Health and Nutrition Examination Survey, the hazard ratio relating mortality over 19.3 years of follow-up to a blood lead increase at baseline from 1.0 to 6.7 µg/dL (10th–90th percentile interval) was 1.37 (95% CI, 1.17–1.60). The population-attributable fraction of blood lead was 18.0% (10.9%–26.1%). The number of preventable ELE-related deaths in the United States would be 412 000 per year (250 000–598 000). In GBD 2010, deaths and disability-adjusted life-years globally lost due to ELE were 0.67 million (0.58–0.78 million) and 0.56% (0.47%–0.66%), respectively. According to the 2017 Organization for Economic Co-operation and Development statistics, ELE-related welfare costs were $1 676 224 million worldwide. Extrapolations from the foregoing metrics assumed causality and reversibility of the association between mortality and blood lead, which at present-day ELE levels in developed nations is not established. Other issues limiting the interpretation of ELE-related population health metrics are the inflation of relative risk based on outdated blood lead levels, not differentiating relative from absolute risk, clustering of risk factors and exposures within individuals, residual confounding, and disregarding noncardiovascular disease and immigration in national ELE-associated welfare estimates. In conclusion, this review highlights the importance of critical thinking in translating population health metrics into cost-effective preventive strategies.
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Affiliation(s)
- Jan A Staessen
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.A.S, L.T., W.-Y.Y., C.-G.Y., F.-F.W., Z.-Y.Z.).,Cardiovascular Research Institute Maastricht, Maastricht University, The Netherlands (J.A.S.).,NPA Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium (J.A.S.)
| | - Lutgarde Thijs
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.A.S, L.T., W.-Y.Y., C.-G.Y., F.-F.W., Z.-Y.Z.)
| | - Wen-Yi Yang
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.A.S, L.T., W.-Y.Y., C.-G.Y., F.-F.W., Z.-Y.Z.).,Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China (W.-Y.Y.)
| | - Cai-Guo Yu
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.A.S, L.T., W.-Y.Y., C.-G.Y., F.-F.W., Z.-Y.Z.).,Department of Endocrinology, Beijing Lu He Hospital and Key Laboratory of Diabetes Prevention and Research, Capital Medical University, China (C.-G.Y.)
| | - Fang-Fei Wei
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.A.S, L.T., W.-Y.Y., C.-G.Y., F.-F.W., Z.-Y.Z.)
| | - Harry A Roels
- Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium (H.A.R., T.S.N.)
| | - Tim S Nawrot
- Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium (H.A.R., T.S.N.)
| | - Zhen-Yu Zhang
- From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.A.S, L.T., W.-Y.Y., C.-G.Y., F.-F.W., Z.-Y.Z.)
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Barry V, Steenland K. Lead exposure and mortality among U.S. workers in a surveillance program: Results from 10 additional years of follow-up. ENVIRONMENTAL RESEARCH 2019; 177:108625. [PMID: 31401374 DOI: 10.1016/j.envres.2019.108625] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 08/01/2019] [Accepted: 08/02/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND A cohort of male lead-exposed workers with past blood lead levels, previously followed for mortality over 12 years, has now been followed for an additional 10 years. This has doubled the number of deaths and allowed for examination of mortality outcomes across a wide range of blood lead levels. OBJECTIVE Evaluate association between lead exposure and 16 causes of death. METHODS The cohort included male workers from 11 U.S. states enrolled in a U.S. lead surveillance program. Maximum blood lead level for each worker was abstracted from surveillance records. Mortality was assessed using the National Death Index. We conducted internal analyses via Cox regression adjusting for age, calendar time, and race. External analyses compared cohort mortality rates with those of the U.S. POPULATION Blood lead categories were defined as 0-<5, 5-<25, 25-<40, and ≥40 μg/dL with the two lower categories combined for outcomes with <5 deaths in the 0-<5 group. RESULTS The cohort (n = 58,368) was followed for a median of 19 years and experienced 6,527 deaths. Average maximum blood lead was 25.9 μg/dL and mean year of first blood lead test was 1997. Strong associations were found between blood lead level with larynx and lung cancer mortality. For these outcomes, hazard ratios and 95% confidence intervals across blood lead categories were 1.0 (ref), 1.1 (0.4-3.2), 3.4 (1.3-9.1) for larynx and 1.0 (ref), 1.6 (1.0-2.5), 2.0 (1.3-3.1), 2.9 (1.9-4.5) for lung (trend p-values = 0.08 and < 0.01, respectively). Positive significant trends were also seen for mortality from brain cancer, chronic obstructive pulmonary disease, ischemic heart disease, and non-hodgkin's lymphoma. Findings suggested associations with chronic renal disease and rectal cancer mortality, although trends were not statistically significant. CONCLUSIONS The additional follow up confirmed previous relationships between lead and mortality and also detected new associations.
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Affiliation(s)
- Vaughn Barry
- Department of Environmental Health, Rollins School of Public Health at Emory University, Atlanta, GA, USA.
| | - Kyle Steenland
- Department of Environmental Health, Rollins School of Public Health at Emory University, Atlanta, GA, USA
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Abubakar K, Muhammad Mailafiya M, Danmaigoro A, Musa Chiroma S, Abdul Rahim EB, Abu Bakar Zakaria MZ. Curcumin Attenuates Lead-Induced Cerebellar Toxicity in Rats via Chelating Activity and Inhibition of Oxidative Stress. Biomolecules 2019; 9:biom9090453. [PMID: 31489882 PMCID: PMC6770944 DOI: 10.3390/biom9090453] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 07/21/2019] [Accepted: 07/25/2019] [Indexed: 12/14/2022] Open
Abstract
Lead (Pb) is a toxic, environmental heavy metal that induces serious clinical defects in all organs, with the nervous system being its primary target. Curcumin is the main active constituent of turmeric rhizome (Curcuma longa) with strong antioxidant and anti-inflammatory properties. This study is aimed at evaluating the therapeutic potentials of curcumin on Pb-induced neurotoxicity. Thirty-six male Sprague Dawley rats were randomly assigned into five groups with 12 rats in the control (normal saline) and 6 rats in each of groups, i.e., the lead-treated group (LTG) (50 mg/kg lead acetate for four weeks), recovery group (RC) (50 mg/kg lead acetate for four weeks), treatment group 1 (Cur100) (50 mg/kg lead acetate for four weeks, followed by 100 mg/kg curcumin for four weeks) and treatment group 2 (Cur200) (50 mg/kg lead acetate for four weeks, followed by 200 mg/kg curcumin for four weeks). All experimental groups received oral treatment via orogastric tube on alternate days. Motor function was assessed using a horizontal bar method. The cerebellar concentration of Pb was evaluated using ICP-MS technique. Pb-administered rats showed a significant decrease in motor scores and Superoxide Dismutase (SOD) activity with increased Malondialdehyde (MDA) levels. In addition, a marked increase in cerebellar Pb concentration and alterations in the histological architecture of the cerebellar cortex layers were recorded. However, treatment with curcumin improved the motor score, reduced Pb concentration in the cerebellum, and ameliorated the markers of oxidative stress, as well as restored the histological architecture of the cerebellum. The results of this study suggest that curcumin attenuates Pb-induced neurotoxicity via inhibition of oxidative stress and chelating activity.
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Affiliation(s)
- Kabeer Abubakar
- Department of Human Anatomy, Faculty of Medicine and Health Sciences, University Putra Malaysia, 43400 Serdang, Selangor Darul Ehsan, Malaysia.
- Department of Human Anatomy, College of Medical Sciences, Federal University Lafia, P.M.B 146 Akunza, Lafia, Nasarawa State, Nigeria.
| | - Maryam Muhammad Mailafiya
- Department of Human Anatomy, Faculty of Medicine and Health Sciences, University Putra Malaysia, 43400 Serdang, Selangor Darul Ehsan, Malaysia
- Department of Human Anatomy, College of Medical Sciences, Federal University Lafia, P.M.B 146 Akunza, Lafia, Nasarawa State, Nigeria
| | - Abubakar Danmaigoro
- Department of Veterinary Anatomy, Faculty of Veterinary Medicine, Usman Danfodiyo University, P.M.B 2346 Sokoto, Nigeria
| | - Samaila Musa Chiroma
- Department of Human Anatomy, Faculty of Medicine and Health Sciences, University Putra Malaysia, 43400 Serdang, Selangor Darul Ehsan, Malaysia
- Department of Human Anatomy, Faculty of Basic Medical Sciences, University of Maiduguri, Borno State, Nigeria
| | - Ezamin Bin Abdul Rahim
- Department of Radiology, Faculty of Medicine and Health Sciences, University Putra Malaysia, 43400 Serdang, Selangor Darul Ehsan, Malaysia.
| | - Md Zuki Abu Bakar Zakaria
- Department of Preclinical Sciences Faculty of Veterinary Medicine, University Putra Malaysia, 43400 Serdang, Selangor Darul Ehsan, Malaysia
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Steenland K, Barry V, Anttila A, Sallmen M, Mueller W, Ritchie P, McElvenny DM, Straif K. Cancer incidence among workers with blood lead measurements in two countries. Occup Environ Med 2019; 76:603-610. [PMID: 31296664 DOI: 10.1136/oemed-2019-105786] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 06/19/2019] [Accepted: 06/27/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Study carcinogenicity of inorganic lead, classified as 'probably carcinogenic' to humans by the International Agency for Research on Cancer (brain, lung, kidney and stomach). METHODS We conducted internal and external analyses for cancer incidence in two cohorts of 29 874 lead-exposed workers with past blood lead data (Finland, n=20 752, Great Britain=9122), with 6790 incident cancers. Exposure was maximum measured blood lead. RESULTS The combined cohort had a median maximum blood lead of 29 μg/dL, a mean first blood lead test of 1977, and was 87% male. Significant (p<0.05) positive trends, using the log of maximum blood lead, were found for brain cancer (malignant), Hodgkin's lymphoma, lung cancer and rectal cancer, while a significant negative trend was found for melanoma. Borderline significant positive trends (0.05≤p≤0.10) were found for oesophageal cancer, meningioma and combined malignant/benign brain cancer. Categorical analyses reflected these trends. Significant interactions by country were found for lung, brain and oesophageal cancer, with Finland showing strong positive trends, and Great Britain showing modest or no trends. Larynx cancer in Finland also showed a positive trend (p=0.05). External analyses for high exposure workers (maximum blood lead >40 μg/dL) showed a significant excess for lung cancer in both countries combined, and significant excesses in Finland for brain and lung cancer. The Great Britain data were limited by small numbers for some cancers, and limited variation in exposure. CONCLUSIONS We found strong positive incidence trends with increasing blood lead level, for several outcomes in internal analysis. Two of these, lung and brain cancer, were sites of a priori interest.
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Affiliation(s)
| | - Vaughn Barry
- Rollins School of Public Health, Atlanta, Georgia, USA
| | | | - Markku Sallmen
- Finnish Institute of Occupational Health, Helsinki, Finland
| | | | | | | | - Kurt Straif
- International Agency for Research on Cancer, Lyon, France
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13
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Barry V, Todd AC, Steenland K. Bone lead associations with blood lead, kidney function and blood pressure among US, lead-exposed workers in a surveillance programme. Occup Environ Med 2019; 76:349-354. [DOI: 10.1136/oemed-2018-105505] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 12/04/2018] [Accepted: 12/08/2018] [Indexed: 11/04/2022]
Abstract
ObjectivesBone lead and past blood lead levels may be more strongly associated with current health effects than current blood lead, representing recent exposure. We examined whether current bone lead was correlated with maximum past blood lead and compared how three lead measures predicted current blood pressure (BP) and kidney function among workers with past occupational lead exposure.MethodsAdult men in a lead surveillance programme residing near New York City were enrolled. Current bone and blood lead, BP and estimated glomerular filtration rate (eGFR) were measured. Maximum past blood lead was obtained from surveillance data. Regression models were used to determine associations of health with different lead measures.ResultsAmong 211 participants, median (IQR) bone, maximum past blood and current blood leads were 13.8 (9.4–19.5) µg lead per bone mineral gram, 29.0 (14.0–38.0) µg/dL and 2.5 (1.5–4.4) µg/dL, respectively. Maximum past and current blood lead were significantly associated with current bone lead in adjusted analyses (both p<0.0001), with associations driven by high blood lead. Bone lead was associated with increased continuous systolic BP (coefficient=0.36; 95% CI 0.05 to 0.67; p=0.02); categorical analyses indicated this was driven by the top two bone lead quartiles. Bone lead was non-significantly associated with decreased (worse) eGFR (coefficient=−0.15; 95% CI −0.36 to 0.07; p=0.18).ConclusionsBone lead was significantly associated with past maximum and current blood lead. The association between bone and current blood lead was possibly driven by bone lead resorption into blood. Bone lead, but not past or current blood lead, was associated with elevated systolic BP.
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Chowdhury R, Ramond A, O'Keeffe LM, Shahzad S, Kunutsor SK, Muka T, Gregson J, Willeit P, Warnakula S, Khan H, Chowdhury S, Gobin R, Franco OH, Di Angelantonio E. Environmental toxic metal contaminants and risk of cardiovascular disease: systematic review and meta-analysis. BMJ 2018; 362:k3310. [PMID: 30158148 PMCID: PMC6113772 DOI: 10.1136/bmj.k3310] [Citation(s) in RCA: 248] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/04/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To conduct a systematic review and meta-analysis of epidemiological studies investigating the association of arsenic, lead, cadmium, mercury, and copper with cardiovascular disease. DESIGN Systematic review and meta-analysis. DATA SOURCES PubMed, Embase, and Web of Science searched up to December 2017. REVIEW METHODS Studies reporting risk estimates for total cardiovascular disease, coronary heart disease, and stroke for levels of arsenic, lead, cadmium, mercury, or copper were included. Two investigators independently extracted information on study characteristics and outcomes in accordance with PRISMA and MOOSE guidelines. Relative risks were standardised to a common scale and pooled across studies for each marker using random effects meta-analyses. RESULTS The review identified 37 unique studies comprising 348 259 non-overlapping participants, with 13 033 coronary heart disease, 4205 stroke, and 15 274 cardiovascular disease outcomes in aggregate. Comparing top versus bottom thirds of baseline levels, pooled relative risks for arsenic and lead were 1.30 (95% confidence interval 1.04 to 1.63) and 1.43 (1.16 to 1.76) for cardiovascular disease, 1.23 (1.04 to 1.45) and 1.85 (1.27 to 2.69) for coronary heart disease, and 1.15 (0.92 to 1.43) and 1.63 (1.14 to 2.34) for stroke. Relative risks for cadmium and copper were 1.33 (1.09 to 1.64) and 1.81 (1.05 to 3.11) for cardiovascular disease, 1.29 (0.98 to 1.71) and 2.22 (1.31 to 3.74) for coronary heart disease, and 1.72 (1.29 to 2.28) and 1.29 (0.77 to 2.17) for stroke. Mercury had no distinctive association with cardiovascular outcomes. There was a linear dose-response relation for arsenic, lead, and cadmium with cardiovascular disease outcomes. CONCLUSION Exposure to arsenic, lead, cadmium, and copper is associated with an increased risk of cardiovascular disease and coronary heart disease. Mercury is not associated with cardiovascular risk. These findings reinforce the importance of environmental toxic metals in cardiovascular risk, beyond the roles of conventional behavioural risk factors.
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Affiliation(s)
- Rajiv Chowdhury
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge CB1 8RN, UK
| | - Anna Ramond
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge CB1 8RN, UK
| | - Linda M O'Keeffe
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Bristol Population Health Science Institute, Bristol Medical School, Bristol, UK
| | - Sara Shahzad
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge CB1 8RN, UK
| | - Setor K Kunutsor
- National Institute for Health Research Bristol Biomedical Research Centre, Bristol, UK
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Translational Health Sciences, Bristol Medical School, Musculoskeletal Research Unit, University of Bristol, Bristol, UK
| | - Taulant Muka
- Institute of Social and Preventive Medicine, Bern, Switzerland
| | - John Gregson
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Peter Willeit
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge CB1 8RN, UK
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Samantha Warnakula
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge CB1 8RN, UK
| | | | - Susmita Chowdhury
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge CB1 8RN, UK
| | | | - Oscar H Franco
- Institute of Social and Preventive Medicine, Bern, Switzerland
| | - Emanuele Di Angelantonio
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge CB1 8RN, UK
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- NHS Blood and Transplant, Cambridge, UK
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Rusiecki J, Stewart P, Lee D, Alexander M, Krstev S, Silverman D, Blair A. Mortality among Coast Guard Shipyard workers: A retrospective cohort study of specific exposures. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2018; 73:4-18. [PMID: 28166467 DOI: 10.1080/19338244.2017.1289891] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 01/27/2017] [Indexed: 06/06/2023]
Abstract
In a previous analysis of a cohort of shipyard workers, we found excess mortality from all causes, lung cancer, and mesothelioma for longer work durations and in specific occupations. Here, we expand the previous analyses by evaluating mortality associated with 5 chemical exposures: asbestos, solvents, lead, oils/greases, and wood dust. Data were gathered retrospectively for 4,702 workers employed at the Coast Guard Shipyard, Baltimore, MD (1950-1964). The cohort was traced through 2001 for vital status. Associations between mortality and these 5 exposures were calculated via standardized mortality ratios (SMRs). We found all 5 substances to be independently associated with mortality from mesothelioma, cancer of the respiratory system, and lung cancer. Findings from efforts to evaluate solvents, lead, oils/greases, and wood dust in isolation of asbestos suggested that the excesses from these other exposures may be due to residual confounding from asbestos exposure.
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Affiliation(s)
- Jennifer Rusiecki
- a Department of Preventive Medicine and Biostatistics , Uniformed Services University , Bethesda , Maryland , USA
| | | | - Dara Lee
- c United States Military Academy , West Point , New York , USA
| | - Melannie Alexander
- a Department of Preventive Medicine and Biostatistics , Uniformed Services University , Bethesda , Maryland , USA
| | - Srmena Krstev
- d Institute of Occupational Health of Serbia , Belgrade , Serbia
| | - Debra Silverman
- e Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics , National Cancer Institute , Rockville , Maryland , USA
| | - Aaron Blair
- e Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics , National Cancer Institute , Rockville , Maryland , USA
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Shaffer RM, Gilbert SG. Reducing occupational lead exposures: Strengthened standards for a healthy workforce. Neurotoxicology 2017; 69:181-186. [PMID: 29128313 DOI: 10.1016/j.neuro.2017.10.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 10/30/2017] [Accepted: 10/31/2017] [Indexed: 11/16/2022]
Abstract
Outdated federal and state occupational lead standards leave workers and their families vulnerable to the adverse effects of lead. Standards should be updated to reflect the best available scientific and medical evidence, which documents harm to multiple organ systems even at low levels of exposure. This commentary will review the inadequacies of existing policies, highlight susceptible populations, and briefly summarize state revision efforts to date. Federal policies must be strengthened to protect all workers and their families from this well-documented hazard.
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Affiliation(s)
- Rachel M Shaffer
- Department of Environmental and Occupational Health Sciences, University of Washington Seattle School of Public Health, 4225 Roosevelt Way NE Suite 100, University of Washington, Seattle, WA, 98105, United States
| | - Steven G Gilbert
- Department of Environmental and Occupational Health Sciences, University of Washington Seattle School of Public Health, 4225 Roosevelt Way NE Suite 100, University of Washington, Seattle, WA, 98105, United States; Institute of Neurotoxicology and Neurological Disorders (INND), 3711 47th Place NE, Seattle, WA, 98105, United States.
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Steenland K, Barry V, Anttila A, Sallmén M, McElvenny D, Todd AC, Straif K. A cohort mortality study of lead-exposed workers in the USA, Finland and the UK. Occup Environ Med 2017; 74:785-791. [PMID: 28546320 DOI: 10.1136/oemed-2017-104311] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 03/30/2017] [Accepted: 05/02/2017] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To investigate further whether inorganic lead is a carcinogen among adults, or associated with increased blood pressure and kidney damage, via a large mortality study. METHODS We conducted internal analyses via Cox regression of mortality in three cohorts of lead-exposed workers with blood lead (BL) data (USA, Finland, UK), including over 88 000 workers and over 14 000 deaths. Our exposure metric was maximum BL. We also conducted external analyses using country-specific background rates. RESULTS The combined cohort had a median BL of 26 µg/dL, a mean first-year BL test of 1990 and was 96% male. Fifty per cent had more than one BL test (mean 7). Significant (p<0.05) positive trends, using the log of each worker's maximum BL, were found for lung cancer, chronic obstructive pulmonary disease (COPD), stroke and heart disease, while borderline significant trends (0.05≤p≤0.10) were found for bladder cancer, brain cancer and larynx cancer. Most results were consistent across all three cohorts. In external comparisons, we found significantly elevated SMRs for those with BLs>40 µg/dL; for bladder, lung and larynx cancer; and for COPD. In a small subsample of the US cohort (n=115) who were interviewed, we found no association between smoking and BL. CONCLUSIONS We found strong positive mortality trends, with increasing BL level, for several outcomes in internal analysis. Many of these outcomes are associated with smoking, for which we had no data. A borderline trend was found for brain cancer, not associated with smoking.
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Affiliation(s)
- Kyle Steenland
- Rollins School PubHealth, Emory University, Atlanta, USA
| | - Vaughn Barry
- Rollins School PubHealth, Emory University, Atlanta, USA
| | | | - Markku Sallmén
- Finnish Institute of Occupational Health, Work, Environment, Helsinki, Finland
| | | | - A C Todd
- Icahn School of Medicine at Mount Sinai, New York, USA
| | - Kurt Straif
- International Agency for Research on Cancer (IARC), Lyon, France
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18
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Chowdhury R, Shah D, Payal AR. Healthy Worker Effect Phenomenon: Revisited with Emphasis on Statistical Methods - A Review. Indian J Occup Environ Med 2017; 21:2-8. [PMID: 29391741 PMCID: PMC5763838 DOI: 10.4103/ijoem.ijoem_53_16] [Citation(s) in RCA: 149] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Known since 1885 but studied systematically only in the past four decades, the healthy worker effect (HWE) is a special form of selection bias common to occupational cohort studies. The phenomenon has been under debate for many years with respect to its impact, conceptual approach (confounding, selection bias, or both), and ways to resolve or account for its effect. The effect is not uniform across age groups, gender, race, and types of occupations and nor is it constant over time. Hence, assessing HWE and accounting for it in statistical analyses is complicated and requires sophisticated methods. Here, we review the HWE, factors affecting it, and methods developed so far to deal with it.
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Affiliation(s)
- Ritam Chowdhury
- Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, USA.,Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Divyang Shah
- Health and Medical Services, Larsen and Toubro Limited, Mumbai, Maharashtra, India
| | - Abhishek R Payal
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
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Tsoi MF, Cheung CL, Cheung TT, Cheung BMY. Continual Decrease in Blood Lead Level in Americans: United States National Health Nutrition and Examination Survey 1999-2014. Am J Med 2016; 129:1213-1218. [PMID: 27341956 DOI: 10.1016/j.amjmed.2016.05.042] [Citation(s) in RCA: 134] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 05/31/2016] [Accepted: 05/31/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Lead is toxic and affects neurodevelopment in children even at low levels. There has been a long-term effort in the United States to reduce exposure to lead in the environment. We studied the latest US population blood lead levels and analyzed its trend. METHOD Blood lead levels in 63,890 participants of the National Health Nutrition and Examination Survey 1999-2014 were analyzed using SPSS Complex Samples v22.0 (IBM Corp, Armonk, NY). RESULTS Mean blood lead levels and 95% confidence intervals (CIs) were 1.65 μg/dL (1.62-1.68), 1.44 μg/dL (1.42-1.47), 1.43 μg/dL (1.40-1.45), 1.29 μg/dL (1.27-1.32), 1.27 μg/dL (1.25-1.29), 1.12 μg/dL (1.10-1.14), 0.97 μg/dL (0.95-0.99), and 0.84 μg/dL (0.82-0.86) in 1999-2000, 2001-2002, 2003-2004, 2005-2006, 2007-2008, 2009-2010, 2011-2012, and 2013-2014, respectively. Blood lead levels decreased significantly (P <.001), and the trend remained significant when stratified by age, gender, ethnicity, and pregnancy status (P <.05). Estimated percentages of children with blood lead level ≥5 μg/dL were 9.9% (95% CI, 7.5-12.9), 7.4% (95% CI, 5.9-9.4), 5.3% (95% CI, 4.1-6.9), 2.9% (95% CI, 2.1-3.9), 3.1% (95% CI, 2.0-4.8), 2.1% (95% CI, 1.5-3.1), 2.0% (95% CI, 1.0-3.6), and 0.5% (95% CI, 0.3-1.0) in 1999-2000, 2001-2002, 2003-2004, 2005-2006, 2007-2008, 2009-2010, 2011-2012, and 2013-2014, respectively. The decreasing trend was significant (P <.05). In children aged 1 to 5 years in the National Health Nutrition and Examination Survey 2011-2014, the estimated 97.5 percentile of blood lead level was 3.48 μg/dL. CONCLUSIONS Blood lead levels have been decreasing in the US population. The reference level also should decrease. It is still important to monitor blood lead levels in the population, especially among pregnant women and children aged 1 to 5 years.
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Affiliation(s)
- Man-Fung Tsoi
- Division of Clinical Pharmacology and Therapeutics, Department of Medicine, The University of Hong Kong, Pokfulam, China
| | - Ching-Lung Cheung
- Division of Clinical Pharmacology and Therapeutics, Department of Medicine, The University of Hong Kong, Pokfulam, China; Research Centre of Heart, Brain, Hormone and Healthy Aging, The University of Hong Kong, Pokfulam, China; Partner State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong, Pokfulam, China; Department of Pharmacology and Pharmacy, The University of Hong Kong, Pokfulam, China
| | - Tommy Tsang Cheung
- Division of Clinical Pharmacology and Therapeutics, Department of Medicine, The University of Hong Kong, Pokfulam, China; Research Centre of Heart, Brain, Hormone and Healthy Aging, The University of Hong Kong, Pokfulam, China
| | - Bernard Man Yung Cheung
- Division of Clinical Pharmacology and Therapeutics, Department of Medicine, The University of Hong Kong, Pokfulam, China; Research Centre of Heart, Brain, Hormone and Healthy Aging, The University of Hong Kong, Pokfulam, China; Partner State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong, Pokfulam, China; Institute of Cardiovascular Science and Medicine, The University of Hong Kong, Pokfulam, China.
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Buononato EV, De Luca D, Galeandro IC, Congedo ML, Cavone D, Intranuovo G, Guastadisegno CM, Corrado V, Ferri GM. Assessment of environmental and occupational exposure to heavy metals in Taranto and other provinces of Southern Italy by means of scalp hair analysis. ENVIRONMENTAL MONITORING AND ASSESSMENT 2016; 188:337. [PMID: 27165601 DOI: 10.1007/s10661-016-5311-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 04/21/2016] [Indexed: 06/05/2023]
Abstract
The monitoring of heavy metals in industrialized areas to study their association with different occupational and environmental factors is carried out in different ways. In this study, scalp hair analysis was used for the assessment of exposure to these metals in the industrial city of Taranto, characterized by a severe environmental pollution. The highest median values were observed for aluminum, barium, cadmium, lead, mercury, and uranium. Moreover, in the industrial area of Taranto, high levels of barium, cadmium, lead, mercury, nickel, and silver were observed in comparison with other Apulia areas. The risk odds ratios (ORs) for observing values above the 50th percentile were elevated for mercury and fish consumption, uranium and milk consumption, lead and female sex, and aluminum and mineral water consumption. No significant increased risk was observed for occupational activities. In a dendrogram of a cluster analysis, three clusters were observed for the different areas of Taranto (Borgo, San Vito, and Statte). A scree plot and score variables plot underline the presence of two principal components: the first regarding antimony, lead, tin, aluminum and silver; the second regarding mercury and uranium. The observed clusters (Borgo, San Vito, and Statte) showed that lead, antimony, tin, aluminum, and silver were the main component. The highest values above the 50th percentile of these minerals, especially lead, were observed in the Borgo area. The observed metal concentration in the Borgo area is compatible with the presence in Taranto of a military dockyard and a reported increase of lung cancer risk among residents of that area.
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Affiliation(s)
- Elena Viola Buononato
- Interdisciplinary Department of Medicine (DIM). Section "B. Ramazzini". Regional University Hospital "Policlinico- Giovanni XXIII" of Bari. Hospital Unit of Occupational Medicine, University of Bari, Piazza Giulio Cesare, 11, 70125, Bari, Italy
| | - Daniela De Luca
- Interdisciplinary Department of Medicine (DIM). Section "B. Ramazzini". Regional University Hospital "Policlinico- Giovanni XXIII" of Bari. Hospital Unit of Occupational Medicine, University of Bari, Piazza Giulio Cesare, 11, 70125, Bari, Italy
| | - Innocenzo Cataldo Galeandro
- Interdisciplinary Department of Medicine (DIM). Section "B. Ramazzini". Regional University Hospital "Policlinico- Giovanni XXIII" of Bari. Hospital Unit of Occupational Medicine, University of Bari, Piazza Giulio Cesare, 11, 70125, Bari, Italy
| | - Maria Luisa Congedo
- Interdisciplinary Department of Medicine (DIM). Section "B. Ramazzini". Regional University Hospital "Policlinico- Giovanni XXIII" of Bari. Hospital Unit of Occupational Medicine, University of Bari, Piazza Giulio Cesare, 11, 70125, Bari, Italy
| | - Domenica Cavone
- Interdisciplinary Department of Medicine (DIM). Section "B. Ramazzini". Regional University Hospital "Policlinico- Giovanni XXIII" of Bari. Hospital Unit of Occupational Medicine, University of Bari, Piazza Giulio Cesare, 11, 70125, Bari, Italy
| | - Graziana Intranuovo
- Interdisciplinary Department of Medicine (DIM). Section "B. Ramazzini". Regional University Hospital "Policlinico- Giovanni XXIII" of Bari. Hospital Unit of Occupational Medicine, University of Bari, Piazza Giulio Cesare, 11, 70125, Bari, Italy
| | - Chiara Monica Guastadisegno
- Interdisciplinary Department of Medicine (DIM). Section "B. Ramazzini". Regional University Hospital "Policlinico- Giovanni XXIII" of Bari. Hospital Unit of Occupational Medicine, University of Bari, Piazza Giulio Cesare, 11, 70125, Bari, Italy
| | - Vincenzo Corrado
- Interdisciplinary Department of Medicine (DIM). Section "B. Ramazzini". Regional University Hospital "Policlinico- Giovanni XXIII" of Bari. Hospital Unit of Occupational Medicine, University of Bari, Piazza Giulio Cesare, 11, 70125, Bari, Italy
| | - Giovanni Maria Ferri
- Interdisciplinary Department of Medicine (DIM). Section "B. Ramazzini". Regional University Hospital "Policlinico- Giovanni XXIII" of Bari. Hospital Unit of Occupational Medicine, University of Bari, Piazza Giulio Cesare, 11, 70125, Bari, Italy.
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Kim MG, Ryoo JH, Chang SJ, Kim CB, Park JK, Koh SB, Ahn YS. Blood Lead Levels and Cause-Specific Mortality of Inorganic Lead-Exposed Workers in South Korea. PLoS One 2015; 10:e0140360. [PMID: 26469177 PMCID: PMC4607363 DOI: 10.1371/journal.pone.0140360] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 09/24/2015] [Indexed: 11/18/2022] Open
Abstract
The objective of this study was to identify the association of blood lead level (BLL) with mortality in inorganic lead-exposed workers of South Korea. A cohort was compiled comprising 81,067 inorganic lead exposed workers working between January 1, 2000, and December 31, 2004. This cohort was merged with the Korean National Statistical Office to follow-up for mortality between 2000 and 2008. After adjusting for age and other carcinogenic metal exposure, all-cause mortality (Relative risk [RR] 1.36, 95% confidence interval [CI] 1.03-1.79), digestive disease (RR 3.23, 95% CI 1.33-7.86), and intentional self-harm (RR 2.92, 95% CI 1.07-7.81) were statistically significantly higher in males with BLL >20 μg/dl than of those with BLL ≤10μg/dl. The RR of males with BLL of 10-20 μg/dl was statistically higher than of those with BLL ≤10μg/dl in infection (RR 3.73. 95% CI, 1.06-13.06). The RRs of females with 10-20 μg/dl BLL was statistically significantly greater than those with BLL <10μg/dl in all-cause mortality (RR 1.93, 95% CI 1.16-3.20) and colon and rectal cancer (RR 13.42, 95% CI 1.21-149.4). The RRs of females with BLL 10-20 μg/dl (RR 10.45, 95% CI 1.74-62.93) and BLL ≥20 μg/dl (RR 12.68, 95% CI 1.69-147.86) was statistically significantly increased in bronchus and lung cancer. The increased suicide of males with ≥20 μg/dl BLLs, which might be caused by major depression, might be associated with higher lead exposure. Also, increased bronchus and lung cancer mortality in female workers with higher BLL might be related to lead exposure considering low smoking rate in females. The kinds of BLL-associated mortality differed by gender.
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Affiliation(s)
- Min-Gi Kim
- Graduate School of Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea
- Departments of Occupational Medicine, Dongguk University Gyeongju Hospital, Gyeongju, Korea
| | - Jae-Hong Ryoo
- Departments of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Se-Jin Chang
- Graduate School of Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Chun-Bae Kim
- Graduate School of Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Jong-Ku Park
- Graduate School of Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Sang-Baek Koh
- Graduate School of Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Yeon-Soon Ahn
- Department of Occupational Medicine, Dongguk University Ilsan Hospital, Goyang-si, Korea
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Sullivan M. More evidence of unpublished industry studies of lead smelter/refinery workers. INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HEALTH 2015; 21:308-13. [PMID: 26070220 PMCID: PMC4727590 DOI: 10.1179/2049396715y.0000000010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 03/20/2015] [Indexed: 10/31/2022]
Abstract
BACKGROUND Lead smelter/refinery workers in the US have had significant exposure to lead and are an important occupational group to study to understand the health effects of chronic lead exposure in adults. Recent research found evidence that studies of lead smelter/refinery workers have been conducted but not published. This paper presents further evidence for this contention. OBJECTIVES To present further evidence of industry conducted, unpublished epidemiologic studies of lead smelter/refinery workers and health outcomes. METHODS Historical research relying on primary sources such as internal industry documents and published studies. RESULTS ASARCO smelter/refinery workers were studied in the early 1980s and found to have increased risk of lung cancer and stroke in one study, but not in another. CONCLUSIONS Because occupational lead exposure is an on-going concern for US and overseas workers, all epidemiologic studies should be made available to evaluate and update occupational health and safety standards.
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Affiliation(s)
- Marianne Sullivan
- Department of Public Health, William Paterson University of New Jersey, 300 Pompton Road, Wayne, NJ, USA
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Survival patterns of lead-exposed workers with end-stage renal disease from Adult Blood Lead Epidemiology and Surveillance program. Am J Med Sci 2015; 349:222-7. [PMID: 25504219 DOI: 10.1097/maj.0000000000000387] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND One previous study has shown that patients with end-stage renal disease (ESRD) with higher blood lead levels (BLLs) have shorter survival, in a cohort without occupational exposure where follow-up began an average of 5 years after dialysis (a survivor population). METHODS The authors studied individuals with at least 1 blood lead test who were part of an occupational lead surveillance program sponsored by the National Institute for Occupational Safety and Health and were diagnosed with ESRD. The authors studied the effect of BLL on survival from time of ESRD diagnosis after adjusting for potential confounders. Cox proportional hazards models were run, in which death was the end point and follow-up time was the time variable. RESULTS There were 434 ESRD cases with 82% males, 65% white and 31% African American; 51% had 1 blood test, whereas the remainder had a median of 5 tests. The median years of follow-up were 2.7 years with 219 deaths in the cohort. After adjusting for covariates (eg, transplantation status, age at diagnosis, glomerular filtration rate, comorbidities and ethnicity), the authors found no significant association between highest measured BLL and mortality across categories; 0 to <5 μg/dL (hazard ratio [HR] = 1.00), 5 to <25 μg/dL (HR = 1.09; 95% confidence interval [CI]: 0.70-1.70), 25 to <40 μg/dL (HR = 1.28; 95% CI: 0.81-2.02), 40 to <50 μg/dL (HR = 0.89; 95% CI: 0.48-1.63) and 50+ μg/dL (HR = 1.09; 95% CI: 0.66-1.81). CONCLUSIONS The authors found no association between BLL and survival after ESRD diagnosis. The authors' finding differs from earlier findings, possibly because the cohort had higher blood leads (25 versus 10 μg/dL), follow-up began at the time of ESRD diagnosis, and BLLs were measured before ESRD incidence.
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