Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, People's Republic of China.
Internal Medicine, Swedish Hospital, 5140 N California Ave, Chicago, IL, 60625, USA.
Environ Sci Pollut Res Int. 2022 Sep;29(45):67483-67503. doi: 10.1007/s11356-022-22353-w. Epub 2022 Aug 2.
Amounting epidemiological evidence has shown detrimental effects of heavy metals on a wide range of diseases. However, the effect of heavy metal exposure on mortality in the general population remains unclear. The primary objective of this study was to clarify the associations between heavy metals and mortality from all causes, cardiovascular disease (CVD), and cancer based on prospective studies. We comprehensively searched Pubmed, Embase, and Web of Science electronic databases to identify studies published from their inception until 1 March 2022. Investigators identified inclusion criteria, extracted study characteristics, and assessed the methodological quality of included studies according to standardized guidelines. Meta-analysis was conducted if the effect estimates of the same outcome were reported in at least three studies. Finally, 42 original studies were identified. The results of meta-analysis showed that cadmium and lead exposure was significantly associated with mortality from all causes, CVD, and cancer in the general population. Moderate evidence suggested there was a link between arsenic exposure and mortality. The adverse effects of mercury and other heavy metals on mortality were inconclusive. Epidemiological evidence for the joint effect of heavy metal exposure on mortality was still indeterminate. In summary, our study provided compelling evidence that exposure to cadmium, lead, and arsenic were associated with mortality from all causes, CVD, and cancer, while the evidence on other heavy metals, for example mercury, was insignificant or indeterminate. Nevertheless, further prospective studies are warranted to explore the joint effects of multiple metal exposure on mortality.
大量的流行病学证据表明，重金属对广泛的疾病有不利影响。然而，重金属暴露对一般人群死亡率的影响仍不清楚。本研究的主要目的是基于前瞻性研究阐明重金属与全因死亡率、心血管疾病 (CVD) 和癌症之间的关系。我们全面检索了 Pubmed、Embase 和 Web of Science 电子数据库，以确定从其成立到 2022 年 3 月 1 日发表的研究。研究人员根据标准化指南确定纳入标准、提取研究特征，并评估纳入研究的方法学质量。如果相同结局的效应估计值在至少三项研究中报告，则进行荟萃分析。最后，确定了 42 项原始研究。荟萃分析的结果表明，镉和铅暴露与一般人群的全因死亡率、心血管疾病和癌症死亡率显著相关。有中度证据表明，砷暴露与死亡率之间存在关联。汞和其他重金属对死亡率的不良影响尚无定论。重金属暴露对死亡率的联合效应的流行病学证据仍不确定。总之，我们的研究提供了令人信服的证据，表明暴露于镉、铅和砷与全因死亡率、心血管疾病和癌症死亡率有关，而其他重金属（例如汞）的证据则不显著或不确定。然而，需要进一步的前瞻性研究来探讨多种金属暴露对死亡率的联合影响。
