| Cadmium Levels in Urine and Mortality among U.S. Adults Andy Menke,1 Paul Muntner,2 Ellen K. Silbergeld,3 Elizabeth A. Platz,1 and Eliseo Guallar1,4 1Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; 2Department of Preventive Medicine, Mount Sinai School of Medicine, New York, New York, USA; 3Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; 4Department of Cardiovascular Epidemiology and Population Genetics, Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain Abstract
Background: Cadmium exposure has been associated with increased all-cause, cancer, and cardiovascular disease mortality. However, studies investigating this association have included participants with considerably higher levels of cadmium than those found in the general population. Objective: We aimed to evaluate the association of creatinine-corrected urinary cadmium levels with all-cause and cause-specific mortality in the U.S. general population. Methods: We analyzed the relationship between cadmium measured in 13,958 adults who participated in the Third National Health and Nutrition Examination Survey in 1988–1994 and were followed through 31 December 2000, and all-cause, cancer, cardiovascular disease, and coronary heart disease mortality. Results: The geometric mean levels of urinary cadmium per gram of urinary creatinine in study participants were 0.28 and 0.40 µg/g for men and women, respectively (p < 0.001) . After multivariable adjustment, including smoking, a major source of cadmium exposure in nonoccupationally exposed populations, the hazard ratios [95% confidence interval (CI) ] for all-cause, cancer, cardiovascular disease, and coronary heart disease mortality associated with a 2-fold higher creatinine-corrected urinary cadmium were, respectively, 1.28 (95% CI, 1.15–1.43) , 1.55 (95% CI, 1.21–1.98) , 1.21 (95% CI, 1.07–1.36) , and 1.36 (95% CI, 1.11–1.66) for men and 1.06 (95% CI, 0.96–1.16) , 1.07 (95% CI, 0.85–1.35) , 0.93 (95% CI, 0.84–1.04) , and 0.82 (95% CI, 0.76–0.89) for women. Conclusions: Environmental cadmium exposure was associated with an increased risk of all-cause, cancer, and cardiovascular disease mortality among men, but not among women. Additional efforts are warranted to fully explain gender differences on the impact of environmental cadmium exposure. Key words: cadmium exposure, cancer, cardiovascular disease, epidemiology, human, mortality, NHANES III. Environ Health Perspect 117:190–196 (2009) . doi:10.1289/ehp.11236 available via http://dx.doi.org/ [Online 3 September 2008]
Address correspondence to E. Guallar, Welch Center for Prevention, Epidemiology, and Clinical Research, 2024 E. Monument St., Room 2-639, Baltimore, MD 21205 USA. Telephone: (410) 614-0574. Fax: (410) 955-0476. E-mail: eguallar@jhsph.edu The authors declare they have no competing financial interests. Received 4 January 2008 ; accepted 3 September 2008.
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