ArticleJournal of exposure science & environmental epidemiology2023
Association between environmental cadmium exposure and increased mortality in the U.S. National Health and Nutrition Examination Survey (1999-2018).
Article in Journal of exposure science & environmental epidemiology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed, 27 citations in OpenAlex.
- Applications of Machine Learning in the Research of Heavy Metal(loid)s-Related Risk: A Scoping Review of Methodology.Toxics · 2026Review
- An Exploration of Machine Learning Methods in Human Biomonitoring.International journal of environmental research and public health · 2026Review
- Heavy Metal Toxicity in Clinical and Environmental Health: Sources, Mechanisms, Diagnostics, and Evidence-Based Management of Mercury, Lead, Cadmium, and Arsenic.International journal of molecular sciences · 2026Review
- Article
- Association of blood essential and non-essential element levels with echocardiographic parameters among Saudi heart failure patients: a case-control study.Frontiers in cardiovascular medicine · 2026Article
- Sex specific associations of urinary metals with TyG index in the Chinese elderly .Scientific reports · 2025Article
- Exposure-Response Associations of Ambient Heavy Metal and Persistent Organic Pollutant with All-Cause and Cause-Specific Mortality: A Prospective Cohort Study.Environment & health (Washington, D.C.) · 2025Article
- Mechanisms of Phytoremediation by Resveratrol against Cadmium Toxicity.Antioxidants (Basel, Switzerland) · 2024Review
- Copper, Iron, Cadmium, and Arsenic, All Generated in the Universe: Elucidating Their Environmental Impact Risk on Human Health Including Clinical Liver Injury.International journal of molecular sciences · 2024Review
- Toxicity Tolerance in the Carcinogenesis of Environmental Cadmium.International journal of molecular sciences · 2024Review
- Association between blood lead, cadmium, selenium levels and hyperlipidemia: A population-based study.PloS one · 2024Article
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Authors and funding
11 authors at 5 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundCadmium (Cd) is toxic to human health and increases overall mortality. In this study, we investigated the association between Cd exposure and all-cause, cardiovascular (CVD), and cancer mortality in the general population and the mediating effect of smoking on these association.
methodsWe used data from U.S. National Health and Nutrition Examination Survey for 1999-2018. To evaluate the hazard ratio (HR) for mortality, a multiple Cox regression analysis was conducted by adjusting for age, sex, race/ethnicity, body mass index, smoking, alcohol, hypertension, diabetes, hyperlipidemia, and history of CVD and cancer. A causal mediation analysis was performed to estimate the effects of smoking.
resultsAmong the 31,637 subjects, 5452 (12.3%) died. Blood Cd concentrations were significantly associated with all-cause (HR 1.473, 95% confidence interval [CI] 1.403-1.546, p < 0.001), CVD (HR 1.445, 95% CI 1.344-1.554, p < 0.001), and cancer (HR 1.496, 95% CI 1.406-1.592, p < 0.001) mortality. Urinary Cd concentrations were also significantly associated with them. Using feature selection via machine learning, the importance of Cd in all-cause and cancer mortality was second only to age. The association between Cd concentrations and all-cause mortality was significant in both ever-smokers and never-smokers. The mediating effect of smoking was estimated at 32%, whereas a large proportion (68%) remained a direct effect of Cd. In a subgroup analysis of subjects with cancer history, blood Cd concentrations were significantly associated with cancer-related deaths in those with a history of breast, gastrointestinal, and skin cancers.
conclusionHigh Cd exposure is an important risk factor for all-cause, CVD, and cancer mortality among the general population. Cd exposure increased the risk of death even in never-smokers, and its effects unrelated to smoking were substantial, suggesting the importance of regulating other sources of Cd exposure such as food and water. IMPACT STATEMENT: Using national large-scale data, we found that low-level environmental exposure to cadmium significantly increased the risk of all-cause, cardiovascular, and cancer mortality in the general population even after adjusting for several risk factors. Although smoking is a major source of cadmium exposure, cadmium was nevertheless significantly associated with all-cause mortality in never-smokers, and the mediating effect of smoking on this association was only 32%. Hence, other sources of cadmium exposure such as food and water may be important.
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