Larsson Susanna C, Wolk Alicja
Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Int J Epidemiol. 2016 Jun;45(3):782-91. doi: 10.1093/ije/dyv086. Epub 2015 May 20.
Cadmium is a toxic heavy metal distributed in the environment. We conducted a systematic review and meta-analysis to examine the association between urinary cadmium concentration and mortality from all causes, cancer and cardiovascular disease (CVD) in the general population.
Studies were identified by searching PubMed and Embase (to 30 March 2015) and the reference lists of retrieved articles. We included prospective studies that reported hazard ratios (HR) with 95% confidence intervals (CI) for the association between urinary cadmium concentration and all-cause, cancer or CVD mortality. A random-effects model was used to combine study-specific results.
Nine cohort studies, including 5600 deaths from all causes, 1332 deaths from cancer and 1715 deaths from CVD, were eligible for inclusion in the meta-analysis. The overall HRs for the highest vs lowest category of urinary cadmium were1.44 (95% CI, 1.25-1.64; I(2 )= 40.5%) for all-cause mortality (six studies), 1.39 (95% CI, 0.96-1.99; I(2 )= 75.9%) for cancer mortality (four studies) and 1.57 (95% CI, 1.27-1.95; I(2 )= 34.0%) for CVD mortality (five studies). In an analysis restricted to six cohort studies conducted in populations with a mean urinary cadmium concentration of ≤1 µg/g creatinine, the HRs were 1.38 (95% CI, 1.17-1.63; I(2 )= 48.3%) for all-cause mortality, 1.56 (95% CI, 0.98-2.47; I(2 )= 81.0%) for cancer mortality and 1.50 (95% CI, 1.18-1.91; I(2 )= 38.2%) for CVD mortality.
Even at low-level exposure, cadmium appears to be associated with increased mortality. Further large prospective studies of cadmium exposure and mortality are warranted.
镉是一种分布于环境中的有毒重金属。我们进行了一项系统评价和荟萃分析，以研究普通人群尿镉浓度与全因死亡率、癌症死亡率和心血管疾病（CVD）死亡率之间的关联。
通过检索PubMed和Embase（截至2015年3月30日）以及检索到的文章的参考文献列表来识别研究。我们纳入了前瞻性研究，这些研究报告了尿镉浓度与全因、癌症或CVD死亡率之间关联的风险比（HR）及95%置信区间（CI）。采用随机效应模型合并各研究的结果。
九项队列研究符合纳入荟萃分析的条件，其中包括5600例全因死亡、1332例癌症死亡和1715例CVD死亡。尿镉最高组与最低组相比，全因死亡率（六项研究）的总体HR为1.44（95%CI，1.25 - 1.64；I² = 40.5%），癌症死亡率（四项研究）的HR为1.39（95%CI，0.96 - 1.99；I² = 75.9%），CVD死亡率（五项研究）的HR为1.57（95%CI，1.27 - 1.95；I² = 34.0%）。在一项仅限于对平均尿镉浓度≤1μg/g肌酐的人群进行的六项队列研究的分析中，全因死亡率的HR为1.38（95%CI，1.17 - 1.63；I² = 48.3%），癌症死亡率的HR为1.56（95%CI，0.98 - 2.47；I² = 81.0%），CVD死亡率的HR为1.50（95%CI，1.18 - 1.91；I² = 38.2%）。
即使在低水平暴露下，镉似乎也与死亡率增加有关。有必要进一步开展关于镉暴露与死亡率的大型前瞻性研究。
