Introduction: Whether environmental exposure to cadmium (Cd) is associated with long-term mortality in adults with and without type 2 diabetes (T2D) is unclear. We examined the association of urinary Cd level with risk of all-cause, cardiovascular disease (CVD) and cancer mortality in U.S. adults in the National Health and Nutrition Examination Survey (NHANES) .

Methods: We performed a prospective analysis of 11765 adults with (n=1900) and without (n=9865) T2D in NHANES 1999-2014 surveys followed up until 2014. We used Cox regression model to estimate the hazard ratio (HR) of outcomes with creatinine-adjusted Cd levels in urine adjusting for age, sex, education, ethnicity, body mass index, smoking status, and medical comorbidities (CVD, hypertension, dyslipidemia and chronic kidney disease) and other ten urinary metal levels.

Results: Of 11765 adults, 10.8% died, and 2.3% and 2.5% died due to CVD and cancer respectively during a median follow-up of 6.7 years. The median (IQR) level of urinary Cd was 0.25 (0.14-0.47) ug/g of creatinine. Per log 10-transformed unit urinary Cd increase was associated with higher risk of all-cause mortality in both with (HR=1.87, 95% CI: 1.29-2.71) and without (HR=2.22, 95% CI: 1.76-2.80) T2D, and CVD (HR=2.42, 95% CI: 1.42-4.13) and cancer (HR=4.01, 95% CI: 2.76-5.83) mortality in adults without T2D. Neutral risk of CVD (HR=1.45, 95% CI: 0.64-3.28) and caner (HR=2.42, 95% CI: 1.00-5.83) mortality were observed in T2D.

Conclusions: Urinary Cd was associated with long-term mortality and varied by diabetes. Further studies on the association of environmental exposure toxic metals with long-term risk of death risk are warranted.


Q.Yang: None. J.Yang: None. A.Yang: None.

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