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The Effects of Metal Exposures on Charlson Comorbidity Index Using Zero-Inflated Negative Binomial Regression Model: NHANES 2011–2016

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Abstract

Background

With the rising incidence of chronic diseases, and the increase of aging population has led to multimorbidity a serious public health problem. The aim of this study was to explore the association between metal exposures and Charlson comorbidity index (CCI), which will provide valuable information for improving quality of life and reducing mortality.

Methods

The study sample consists of three continuous cycles (2011–2016) of the National Health and Nutrition Examination Survey (NHANES), and 4901 eligible subjects were included in the study. Zero-inflated negative binomial (ZINB) model was utilized to investigate the effects in metal exposures on CCI, which includes spot urine (arsenic, mercury, and cadmium), whole blood (manganese, selenium, and lead), and serum (copper and zinc).

Results

In count part (CCI ≥ 0), holding other variables constant, the expected change in CCI for a one-unit increase in blood selenium is 0.997 (RR = 0.997, p = 0.017). In logit part (CCI = 0), the log odds of having CCI equals zero would increase by 0.659, 1.073, and 0.963 for every additional urinary cadmium (OR = 0.659, p = 0.007), blood lead (OR = 1.073, p = 0.023), blood manganese (OR = 0.963, p = 0.025), respectively.

Conclusions

Our findings indicated that cadmium and manganese were likely to increase mortality. Inversely, selenium and lead might be positive on people’s health. The findings may be extremely essential for preventing diseases and improving life quality.

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References

  1. Murray CJ, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C et al (2012) Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet (London, England) 380:2197–2223

    Article  Google Scholar 

  2. Johnston MC, Crilly M, Black C, Prescott GJ, Mercer SW (2019) Defining and measuring multimorbidity: a systematic review of systematic reviews. Eur J Pub Health 29:182–189

    Article  Google Scholar 

  3. Harding JL, Pavkov ME, Magliano DJ, Shaw JE, Gregg EW (2019) Global trends in diabetes complications: a review of current evidence. Diabetologia 62:3–16

    Article  PubMed  Google Scholar 

  4. (2016) Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet (London, England) 388:1459–1544

  5. Eroglu SA, Gunen H, Yakar HI, Yildiz E, Kavas M, Duman D (2019) Influence of comorbidities in long-term survival of chronic obstructive pulmonary disease patients. J Thorac Dis 11:1379–1386

    Article  PubMed  Google Scholar 

  6. Antai D (2011) Regional inequalities in under-5 mortality in Nigeria: a population-based analysis of individual- and community-level determinants. Popul Health Metrics 9:6

    Article  Google Scholar 

  7. Vallee A, Gabet A, Deschamps V, Blacher J, Olie V (2019) Relationship between nutrition and alcohol consumption with blood pressure: the ESTEBAN survey. Nutrients 11

  8. Yang L, Cao C, Kantor ED, Nguyen LH, Zheng X, Park Y, Giovannucci EL, Matthews CE, Colditz GA, Cao Y (2019) Trends in Sedentary Behavior Among the US Population, 2001-2016. Jama 321:1587–1597

    Article  PubMed  Google Scholar 

  9. Lanphear BP, Rauch S, Auinger P, Allen RW, Hornung RW (2018) Low-level lead exposure and mortality in US adults: a population-based cohort study. Lancet Public Health 3:e177–e184

    Article  PubMed  Google Scholar 

  10. Sun Y, Zhou Q, Zheng J (2019) Nephrotoxic metals of cadmium, lead, mercury and arsenic and the odds of kidney stones in adults: an exposure-response analysis of NHANES 2007-2016. Environ Int 132:105115

    Article  CAS  PubMed  Google Scholar 

  11. Lee BK, Kim Y (2011) Relationship between blood manganese and blood pressure in the Korean general population according to KNHANES 2008. Environ Res 111:797–803

    Article  CAS  PubMed  Google Scholar 

  12. Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383

    Article  CAS  Google Scholar 

  13. Schelde AB, Schmidt M, Madsen M, Nielsen SS, Frokiaer J, Christiansen CF (2019) Impact of the Charlson Comorbidity Index score on risk prediction by single-photon emission computed tomography myocardial perfusion imaging following myocardial infarction. Clin Epidemiol 11:901–910

    Article  PubMed  Google Scholar 

  14. Chen KJ, Gao SS, Duangthip D, Li SKY, Lo ECM, Chu CH (2017) Dental caries status and its associated factors among 5-year-old Hong Kong children: a cross-sectional study. BMC Oral Health 17:121

    Article  PubMed  Google Scholar 

  15. Pittman B, Buta E, Krishnan-Sarin S, O’Malley SS, Liss T, Gueorguieva R (2018) Models for analyzing zero-inflated and overdispersed count data: an application to cigarette and marijuana use. Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco; e-pub ahead of print 2018/06/19. https://doi.org/10.1093/ntr/nty072

  16. CDC/NCHS (2019) NHANES - questionnaires, datasets, and related documentation. Available at: URL: https://www.cdc.gov/nchs/nhanes/index.htm

  17. National Center for Environmental Health (2018) NHANES 2015–2016: laboratory component: serum metals. Centers for Disease Control and Prevention Website. Available at: URL: https://wwwn.cdc.gov/nchs/data/nhanes/2015-2016/labmethods/CUSEZN_I_MET.PDF

  18. National Center for Environmental Health (2018) NHANES 2015–2016: Laboratory component: whole blood metals. Centers for Disease Control and Prevention Website. Available at: URL: https://wwwn.cdc.gov/nchs/data/nhanes/2015-2016/labmethods/PBCD_I_met.pdf

  19. National Center for Environmental Health (2018) NHANES 2015–2016: laboratory component: urinary metals. Centers for Disease Control and Prevention Website. Available at: URL: https://wwwn.cdc.gov/nchs/data/nhanes/2015-2016/labmethods/UTAS_UTASS_UM_UMS_I_MET.PDF

  20. Kim CY, Sivasundaram L, LaBelle MW, Trivedi NN, Liu RW, Gillespie RJ (2018) Predicting adverse events, length of stay, and discharge disposition following shoulder arthroplasty: a comparison of the Elixhauser Comorbidity Measure and Charlson Comorbidity Index. J Shoulder Elb Surg 27:1748–1755

    Article  Google Scholar 

  21. Gervilla E, Cajal B, Palmer A (2011) Quantification of the influence of friends and antisocial behaviour in adolescent consumption of cannabis using the ZINB model and data mining. Addict Behav 36:368–374

    Article  Google Scholar 

  22. Madrigal JM, Persky V, Pappalardo A, Argos M (2018) Association of heavy metals with measures of pulmonary function in children and youth: results from the National Health and Nutrition Examination Survey (NHANES). Environ Int 121:871–878

    Article  CAS  PubMed  Google Scholar 

  23. Larsson SC, Wolk A (2016) Urinary cadmium and mortality from all causes, cancer and cardiovascular disease in the general population: systematic review and meta-analysis of cohort studies. Int J Epidemiol 45:782–791

    Article  PubMed  Google Scholar 

  24. Hsu CW, Weng CH, Lee CC, Lin-Tan DT, Chu PH, Chen KH, Yen TH, Huang WH (2017) Urinary cadmium levels predict mortality of patients with acute heart failure. Ther Clin Risk Manag 13:379–386

    Article  CAS  PubMed  Google Scholar 

  25. Ozturk IM, Buyukakilli B, Balli E, Cimen B, Gunes S, Erdogan S (2009) Determination of acute and chronic effects of cadmium on the cardiovascular system of rats. Toxicol Mech Methods 19:308–317

    Article  CAS  PubMed  Google Scholar 

  26. Rani A, Kumar A, Lal A, Pant M (2014) Cellular mechanisms of cadmium-induced toxicity: a review. Int J Environ Health Res 24:378–399

    Article  CAS  PubMed  Google Scholar 

  27. Asara Y, Marchal JA, Carrasco E, Boulaiz H, Solinas G, Bandiera P, Garcia M, Farace C, Montella A, Madeddu R (2013) Cadmium modifies the cell cycle and apoptotic profiles of human breast cancer cells treated with 5-fluorouracil. Int J Mol Sci 14:16600–16616

    Article  PubMed  Google Scholar 

  28. Spangler AH, Spangler JG (2009) Groundwater manganese and infant mortality rate by county in North Carolina: an ecological analysis. EcoHealth 6:596–600

    Article  PubMed  Google Scholar 

  29. Grochowski C, Blicharska E, Baj J, Mierzwińska A, Brzozowska K, Forma A, Maciejewski R (2019) Serum iron, magnesium, copper, and manganese levels in alcoholism: a systematic review. Molecules 24(7):1361

  30. Jiang Y, Zheng W (2005) Cardiovascular toxicities upon manganese exposure. Cardiovasc Toxicol 5:345–354

    Article  CAS  PubMed  Google Scholar 

  31. Zheng G, Xu X, Li B, Wu K, Yekeen TA, Huo X (2013) Association between lung function in school children and exposure to three transition metals from an e-waste recycling area. J Expo Sci Environ Epidemiol 23:67–72

    Article  CAS  PubMed  Google Scholar 

  32. Giovannini S, Onder G, Lattanzio F, Bustacchini S, Di Stefano G, Moresi R et al (2018) Selenium concentrations and mortality among community-dwelling older adults: results from IlSIRENTE study. J Nutr Health Aging 22:608–612

    Article  CAS  PubMed  Google Scholar 

  33. Schwingshackl L, Boeing H, Stelmach-Mardas M, Gottschald M, Dietrich S, Hoffmann G et al (2017) Dietary supplements and risk of cause-specific death, cardiovascular disease, and cancer: a systematic review and meta-analysis of primary prevention trials. Adv Nutr (Bethesda, Md) 8:27–39

    Article  Google Scholar 

  34. Park K, Rimm EB, Siscovick DS, Spiegelman D, Manson JE, Morris JS, Hu FB, Mozaffarian D (2012) Toenail selenium and incidence of type 2 diabetes in U.S. men and women. Diabetes Care 35:1544–1551

    Article  CAS  PubMed  Google Scholar 

  35. Salonen JT, Salonen R, Seppanen K, Rinta-Kiikka S, Kuukka M, Korpela H et al (1991) Effects of antioxidant supplementation on platelet function: a randomized pair-matched, placebo-controlled, double-blind trial in men with low antioxidant status. Am J Clin Nutr 53:1222–1229

    Article  CAS  PubMed  Google Scholar 

  36. Flores-Mateo G, Navas-Acien A, Pastor-Barriuso R, Guallar E (2006) Selenium and coronary heart disease: a meta-analysis. Am J Clin Nutr 84:762–773

    Article  CAS  PubMed  Google Scholar 

  37. Scinicariello F, Buser MC, Mevissen M, Portier CJ (2013) Blood lead level association with lower body weight in NHANES 1999-2006. Toxicol Appl Pharmacol 273:516–523

    Article  CAS  PubMed  Google Scholar 

  38. Bulka CM, Persky VW, Daviglus ML, Durazo-Arvizu RA, Argos M (2019) Multiple metal exposures and metabolic syndrome: a cross-sectional analysis of the National Health and Nutrition Examination Survey 2011-2014. Environ Res 168:397–405

    Article  CAS  Google Scholar 

  39. Menke A, Muntner P, Batuman V, Silbergeld EK, Guallar E (2006) Blood lead below 0.48 micromol/L (10 microg/dL) and mortality among US adults. Circulation 114:1388–1394

    Article  CAS  PubMed  Google Scholar 

  40. Eshak ES, Iso H, Yamagishi K, Maruyama K, Umesawa M, Tamakoshi A (2018) Associations between copper and zinc intakes from diet and mortality from cardiovascular disease in a large population-based prospective cohort study. J Nutr Biochem 56:126–132

    Article  CAS  Google Scholar 

  41. Tsai CC, Wu CL, Kor CT, Lian IB, Chang CH, Chang TH et al (2018) Prospective associations between environmental heavy metal exposure and renal outcomes in adults with chronic kidney disease. Nephrology (Carlton, Vic) 23:830–836

    Article  CAS  Google Scholar 

  42. Linko R, Karlsson S, Pettila V, Varpula T, Okkonen M, Lund V et al (2011) Serum zinc in critically ill adult patients with acute respiratory failure. Acta Anaesthesiol Scand 55:615–621

    Article  CAS  Google Scholar 

  43. Cander B, Dundar ZD, Gul M, Girisgin S (2011) Prognostic value of serum zinc levels in critically ill patients. J Crit Care 26:42–46

    Article  CAS  Google Scholar 

  44. Lee BK, Kim Y (2016) Association of blood cadmium level with metabolic syndrome after adjustment for confounding by serum ferritin and other factors: 2008-2012 Korean National Health and Nutrition Examination Survey. Biol Trace Elem Res 171:6–16

    Article  CAS  PubMed  Google Scholar 

  45. (2011) Cadmium exposure and kidney stone formation in the general population—an analysis of the National Health and Nutrition Examination Survey III data. J Endourol 25:875–880

  46. Cho HM, Cho DY, Kim MY, Yang SW, Seo YS, Kim KN (2016) combined effect of blood cadmium and lead levels on coronary heart disease prediction risk in Korean men. Angiology 67:582–586

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

The authors thank the National Center for Health Statistics of the Centers for Disease Control and Prevention for sharing the data.

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Authors and Affiliations

  1. Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 1163 Xinmin Avenue, Changchun, 130021, People’s Republic of China

    Hantong Zhao, Yingan Pan, Changcong Wang, Yinpei Guo, Nan Yao, Han Wang & Bo Li

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  1. Hantong Zhao
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  2. Yingan Pan
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  7. Bo Li
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Contributions

BL and HZ designed the study; HZ, CW, and YP performed the study; HZ, NY, and YG analyzed the data and drafted the manuscript; HZ and HW participated amending the manuscript. All authors approved the final version of the manuscript.

Availability of Data and Materials

The datasets generated and/or analyzed during the current study are publicly available from the NHANES Web site (https://wwwn.cdc.gov/nchs/nhanes/continuousnhanes/default.aspx?BeginYear=2013).

Corresponding author

Correspondence to Bo Li.

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Conflict of Interest

The authors declare that they have no competing interests.

Ethics Approval

Study protocols for NHANES were approved by the National Center for Health Statistics ethnics review board.

Consent to Participate

All the participants signed the informed consent before participating in the study.

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Not applicable.

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Appendix

Appendix

Table 4 Scores of various diseases included in this study, NHANES 2011–2016 (n = 4901)
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Table 5 Predictors of Carlson comorbidity index among metal exposures below LOD, NHANES 2011–2016 (n = 4901)
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Zhao, H., Pan, Y., Wang, C. et al. The Effects of Metal Exposures on Charlson Comorbidity Index Using Zero-Inflated Negative Binomial Regression Model: NHANES 2011–2016. Biol Trace Elem Res 199, 2104–2111 (2021). https://doi.org/10.1007/s12011-020-02331-4

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