Association of serum five heavy metals level with all-cause and cause-specific mortality: a large population-based cohort study

Abstract

The study aimed to explore the association between five heavy metals exposure (Cadmium, Lead, Mercury, Manganese, and Selenium) and mortality [all-cause, cardiovascular disease (CVD), and cancer-related]. We integrated the data into the National Health and Nutrition Examination Survey from 2011 to 2018 years. A total of 16,092 participants were recruited. The link between heavy metals exposure and mortality was analyzed by constructing a restricted cubic spline (RCS) curve, Cox proportional hazard regression model, and subgroup analysis. The RCS curve was used to show a positive linear relationship between Cadmium, Lead, and all-cause mortality. In contrast, there was a negative linear correlation between Mercury and all-cause mortality. Additionally, Manganese and Selenium also had a J-shaped and L-shaped link with all-cause mortality. The positive linear, positive linear, negative liner, J-shaped, and L-shaped relationships were observed for Cadmium, Lead, Mercury, Manganese, and Selenium and CVD mortality, respectively. Cadmium, Lead, Mercury, and Selenium were observed to exhibit positive linear, U-shaped, negative linear, and L-shaped relationships with cancer-related mortality, respectively. There was an increase and then a decrease in the link between Manganese and cancer-related morality. This study revealed the correlation between the content of different elements and different types of mortality in the U.S. general population.

Keywords:

• All-cause mortality
• cardiovascular disease mortality
• cancer-related mortality
• serum heavy metals level
• risk assessment

Acknowledgments

Thanks to all the volunteers who took part in the NHANES.

Ethical approval

All NHANES protocols were approved by the National Center for Health Statistics ethics review board, and written informed consent was obtained from all participants.

Author contributions

Shengjue Xiao and Zhenwei Wang: conceptualization, methodology, software. Ronghua Zuo: data curation, writing-original draft preparation. Yufei Zhou, Zhongkai Wang, and Tian Chen: software, validation. Naifeng Liu, Shengjue Xiao, and Zhenwei Wang: writing-reviewing and editing. All authors read and approved the final manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The datasets for this study can be found at https://www.cdc.gov/nchs/nhanes/.

Additional information

Funding

This work was supported by the Jiangsu Provincial Key Medical Discipline (Laboratory) (Project name: Cardiology; Grant number: ZDXK202207; Project leader: Genshan Ma).