Academic journal article Environmental Health Perspectives

Reduction in Cadmium Exposure in the United States Population, 1988-2008: The Contribution of Declining Smoking Rates

Academic journal article Environmental Health Perspectives

Reduction in Cadmium Exposure in the United States Population, 1988-2008: The Contribution of Declining Smoking Rates

Article excerpt

BACKGROUND: Public health policies such as tobacco control, air pollution reduction, and hazardous waste remediation may have reduced cadmium exposure among U.S. adults. However, trends in urine cadmium, a marker of cumulative cadmium exposure, have not been evaluated.

OBJECTIVES: We estimated the trends in urine cadmium concentrations in U.S. adults using data from the National Health and Nutrition Examination Surveys (NHANES) from 1988 to 2008. We also evaluated the impact of changes in the distribution of available cadmium determinants (age, sex, race, education, body mass index, smoking, and occupation) at the population level to explain cadmium trends.

METHODS: The study population included 19,759 adults [greater than or equal to] 20 years of age with measures of urine cadmium and cadmium determinants.

RESULTs: Age-adjusted geometric means of urine cadmium concentrations were 0.36, 0.35, 0.27, 0.27, 0.28, 0.25, and 0.26 [micro]g/g creatinine in 1988-1991, 1991-1994, 1999-2000, 2001-2002, 2003-2004, 2005-2006, and 2007-2008, respectively. The age, sex, and race/ethnicity-adjusted percent reduction in urine cadmium geometric means comparing 1999-2002 and 2003-2008 with 1988-1994 were 27.8% (95% confidence interval: 22.3%, 32.9%) and 34.3% (29.9%, 38.4%), respectively (p-trend < 0.001), with reductions in all participant subgroups investigated. In never smokers, reductions in serum cotinine accounted for 15.6% of the observed reduction. In ever smokers, changes in smoking cessation, and cumulative and recent dose accounted for 17.1% of the observed reduction.

CONCLUSIONS: Urine cadmium concentrations decreased markedly between 1988 and 2008. Declining smoking rates and changes in exposure to tobacco smoke may have played an important role in the decline of urine cadmium concentrations, benefiting both smokers and nonsmokers. Cadmium has been associated to several health outcomes in NHANES 1999-2008. Consequently, despite the observed decline, further reduction in cadmium exposure is needed.

KEY WORDS: cadmium, cigarette smoking, determinants, NHANES, trends. Environ Health Perspect 120:204-209 (2012). http://dx.doi.org/1289/ehp.1104020 [Online 7 November 2011]

Cadmium is a highly toxic and carcinogenic metal widely distributed in the environment. Mounting evidence from general populations exposed to low or moderate levels points to cadmium as a risk factor a broad spectrum of health conditions, including cardiovascular, kidney, and hone disease (Jarup and Akesson 2009; Nordberg et al. 2007; Satarug er al. 2010). Smoking, diet (leafy and root vegetables, grains, and offal), ambient air, and occupation exposures (metal and mining industry, transportation and repairing services) are the main sources of cadmium exposure (Jarup and Akesson 2009; Nordherg et al. 2007; Satarug et al. 2010; Yassin and Martonik 2004). Public health policies such as tobacco control [Breysse and Navas-Acien 2010; U.S. National Center for Health Statistics (NCHS) 2010b], air pollution reduction [U.S. Environmental Protection Agency (EPA) 2010a, 2010b], and hazardous waste remediation (U.S. EPA 2010c) may have resulted in decreased cadmium exposure in the U.S. population. In the U.S. population, however, trends in cadmium exposure over time have not been evaluated.

The National Health and Nutrition Examination Survey (NHANES) provides periodic monitoring of the health of the U.S. population. Since 1988, NHANES has included the measurement of cadmium Concentrations in urine (NCHS 2010a. Urine cadmium is a bio-marker of cumulative cadmium exposure and internal dose that reflects cadmium concentrations in the renal cortex (Jarup and Akesson 2009; Nordherg et al. 2007). Our objective was to estimate trends in cadmium exposure, as measured by urine cadmium, in the general U.S. population from 1988 to 2008. In addition, we evaluated the impact of population changes in the distribution of cadmium determinants, in particular smoking, to explain changes in urine cadmium concentrations over time. …

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