Dai Lingyu, Zhou Qian, Gao Yu, Su Guannan, Jiang Qingyan, Xia Lan, Yang Peizeng
Ophthalmology Medical Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory for the Prevention and Treatment of Major Blinding Eye Diseases, Chongqing Branch (Municipality Division) of National Clinical Research Centre for Ocular Diseases, Chongqing, China.
Front Public Health. 2025 May 9;13:1583105. doi: 10.3389/fpubh.2025.1583105. eCollection 2025.
Heavy metals exposure has been widely referred to as a risk factor for human health. However, studies on the potential impact of heavy metals on visual disability are limited. Herein, this study aims to investigate the associations of urinary and blood heavy metals with visual disability in adults.
A total of 4,284 eligible participants in the 2013-2018 National Health and Nutrition Examination Survey (NHANES) were enrolled in our cross-sectional study. The urinary barium (Ba), cadmium (Cd), cesium (Cs), cobalt (Co), molybdenum (Mo), lead (Pb), antimony (Sb), thallium (Tl), tin (Sn), tungsten (Tu), and mercury (Hg) and blood Pb, Cd, and Hg were included for analysis. We used multivariate logistic regression, weighted quantile sum (WQS) regression, quantile-based gcomputation (qgcomp) regression, and Bayesian kernel machine regression (BKMR) to assess the mixed-metal effect on visual disability. The subgroup analysis was stratified by age.
In the single metal exposure model, the risk of visual disability increased by 39.2%, 22.6%, 25.6%, and 17.9% for each unit increase in urinary Cd, Pb, Sn, and Tu, respectively (all < 0.05). Meanwhile, the risk of visual disability increased by 40.6% and 22.7% per unit increase in blood Ln-Pb and Ln-Cd, respectively ( = 0.034 and 0.018). In mixed metal effect analysis, WQS, qgcomp, and BKMR models consistently demonstrated a positive association between blood and urine metal co-exposure and visual disability. Furthermore, we found that Cd and Pb were the top-weighted metals responsible for the overall effect. However, these associations were not pronounced in the older adults.
Our findings suggested that Cd, Pb, Sn, and Tu were identified as independent risk factors for visual disability. Furthermore, exposure to mixed metals could increase the risk of visual disability, to which Cd and Pb were the greatest contributors.
重金属暴露已被广泛认为是人类健康的一个风险因素。然而，关于重金属对视力残疾潜在影响的研究有限。在此，本研究旨在调查成人尿液和血液中的重金属与视力残疾之间的关联。
共有4284名符合条件的参与者被纳入我们的横断面研究，这些参与者来自2013 - 2018年国家健康与营养检查调查（NHANES）。分析指标包括尿钡（Ba）、镉（Cd）、铯（Cs）、钴（Co）、钼（Mo）、铅（Pb）、锑（Sb）、铊（Tl）、锡（Sn）、钨（Tu）和汞（Hg）以及血液中的Pb、Cd和Hg。我们使用多变量逻辑回归、加权分位数和（WQS）回归、基于分位数的g计算（qgcomp）回归以及贝叶斯核机器回归（BKMR）来评估混合金属对视力残疾的影响。亚组分析按年龄分层。
在单一金属暴露模型中，尿Cd、Pb、Sn和Tu每增加一个单位，视力残疾风险分别增加39.2%、22.6%、25.6%和17.9%（均P<0.05）。同时，血液中Ln - Pb和Ln - Cd每增加一个单位，视力残疾风险分别增加40.6%和22.7%（P = 0.034和0.018）。在混合金属效应分析中，WQS、qgcomp和BKMR模型一致表明血液和尿液中金属共同暴露与视力残疾之间存在正相关。此外，我们发现Cd和Pb是对总体效应加权最大的金属。然而，这些关联在老年人中并不明显。
我们的研究结果表明，Cd、Pb、Sn和Tu被确定为视力残疾的独立危险因素。此外，混合金属暴露会增加视力残疾风险，其中Cd和Pb的贡献最大。
