Associations of urinary metal concentrations with anemia: A cross-sectional study of Chinese community-dwelling elderly

Guojie Qiao; Zhuoheng Shen; Siyu Duan; Rui Wang; Pei He; Zhongyuan Zhang; Yuqing Dai; Meiyan Li; Yue Chen; Xiaoyu Li; Yi Zhao; Zhihong Liu; Huifang Yang; Rui Zhang; Suzhen Guan; Jian Sun

doi:10.1016/j.ecoenv.2023.115828

Associations of urinary metal concentrations with anemia: A cross-sectional study of Chinese community-dwelling elderly

Ecotoxicol Environ Saf. 2024 Jan 15:270:115828. doi: 10.1016/j.ecoenv.2023.115828. Epub 2023 Dec 20.

Authors

Guojie Qiao¹, Zhuoheng Shen², Siyu Duan², Rui Wang², Pei He², Zhongyuan Zhang², Yuqing Dai², Meiyan Li², Yue Chen², Xiaoyu Li², Yi Zhao², Zhihong Liu², Huifang Yang², Rui Zhang³, Suzhen Guan⁴, Jian Sun⁵

Affiliations

¹ Radioimmunity Center, Shaanxi Provincial People's Hospital, Xi'an, 710069, Shaanxi, P.R. China. Electronic address: qgj2016@hainanu.edu.cn.
² School of Public Health, Ningxia Medical University, Yinchuan, 750004, Ningxia, P.R. China; Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan, 750004, Ningxia, P.R. China.
³ School of Public Health, Ningxia Medical University, Yinchuan, 750004, Ningxia, P.R. China; Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan, 750004, Ningxia, P.R. China; Ningxia Key Laboratory of Cerebrocranial Disease, Incubation Base of National Key Laboratory, Ningxia Medical University, Yinchuan, 750004, Ningxia, P.R. China.
⁴ School of Public Health, Ningxia Medical University, Yinchuan, 750004, Ningxia, P.R. China; Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan, 750004, Ningxia, P.R. China. Electronic address: guansz_nx2017@sina.com.
⁵ School of Public Health, Ningxia Medical University, Yinchuan, 750004, Ningxia, P.R. China; Key Laboratory of Environmental Factors and Chronic Disease Control, Yinchuan, 750004, Ningxia, P.R. China. Electronic address: 20180016@nxmu.edu.cn.

PMID: 38118331
DOI: 10.1016/j.ecoenv.2023.115828

Abstract

Background: Anemia seriously affects the health and quality of life of the older adult population and may be influenced by various types of environmental metal exposure. Current studies on metals and anemia are mainly limited to single metals, and the association between polymetals and their mixtures and anemia remains unclear.

Methods: We determined 11 urinary metal concentrations and hemoglobin levels in 3781 participants. Binary logistic regression and restricted cubic spline (RCS) model were used to estimate the association of individual metals with anemia. We used Bayesian kernel machine regression (BKMR) and Quantile g-computation (Q-g) regression to assess the overall association between metal mixtures and anemia and identify the major contributing elements. Stratified analyses were used to explore the association of different metals with anemia in different populations.

Results: In a single-metal model, nine urinary metals significantly associated with anemia. RCS analysis further showed that the association of arsenic (As) and copper (Cu) with anemia was linear, while cobalt, molybdenum, thallium, and zinc were non-linear. The BKMR model revealed a significant positive association between the concentration of metal mixtures and anemia. Combined Q-g regression analysis suggested that metals such as Cu, As, and tellurium (Te) were positively associated with anemia, with Te as the most significant contributor. Stratified analyses showed that the association of different metals with anemia varied among people of different sexes, obesity levels, lifestyle habits, and blood pressure levels.

Conclusions: Multiple metals are associated with anemia in the older adult population. A significant positive association was observed between metal mixture concentrations and anemia, with Te being the most important factor. The association between urinary metal concentrations and anemia is more sensitive in the non-hypertensive populations.

Keywords: Anemia; Cross-sectional study; Metal mixture; Older people; Urinary metals.

MeSH terms

Aged
Anemia* / epidemiology
Arsenic* / urine
Bayes Theorem
China / epidemiology
Cross-Sectional Studies
Humans
Independent Living
Metals / urine
Quality of Life

Substances

Metals
Arsenic