title: Cadmium levels in urine and mortality among U.S. adults.
abstract: BACKGROUND
  Cadmium exposure has been associated with increased all-cause, cancer, and cardiovascular disease mortality. However, studies investigating this association have included participants with considerably higher levels of cadmium than those found in the general population.
  
  
  OBJECTIVE
  We aimed to evaluate the association of creatinine-corrected urinary cadmium levels with all-cause and cause-specific mortality in the U.S. general population.
  
  
  METHODS
  We analyzed the relationship between cadmium measured in 13,958 adults who participated in the Third National Health and Nutrition Examination Survey in 1988-1994 and were followed through 31 December 2000, and all-cause, cancer, cardiovascular disease, and coronary heart disease mortality.
  
  
  RESULTS
  The geometric mean levels of urinary cadmium per gram of urinary creatinine in study participants were 0.28 and 0.40 microg/g for men and women, respectively (p < 0.001). After multivariable adjustment, including smoking, a major source of cadmium exposure in nonoccupationally exposed populations, the hazard ratios [95% confidence interval (CI)] for all-cause, cancer, cardiovascular disease, and coronary heart disease mortality associated with a 2-fold higher creatinine-corrected urinary cadmium were, respectively, 1.28 (95% CI, 1.15-1.43), 1.55 (95% CI, 1.21-1.98), 1.21 (95% CI, 1.07-1.36), and 1.36 (95% CI, 1.11-1.66) for men and 1.06 (95% CI, 0.96-1.16), 1.07 (95% CI, 0.85-1.35), 0.93 (95% CI, 0.84-1.04), and 0.82 (95% CI, 0.76-0.89) for women.
  
  
  CONCLUSIONS
  Environmental cadmium exposure was associated with an increased risk of all-cause, cancer, and cardiovascular disease mortality among men, but not among women. Additional efforts are warranted to fully explain gender differences on the impact of environmental cadmium exposure.
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: Andy
authors.initials: A
authors.lastname: Menke
authors.forename: Paul
authors.initials: P
authors.lastname: Muntner
authors.forename: Ellen K
authors.initials: EK
authors.lastname: Silbergeld
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Platz
authors.forename: Eliseo
authors.initials: E
authors.lastname: Guallar
mesh_terms: D000328:Adult; D002104:Cadmium / Q000009:adverse effects* / Q000652:urine*; D002318:Cardiovascular Diseases / Q000401:mortality / Q000652:urine; D016001:Confidence Intervals; D003327:Coronary Disease / Q000401:mortality / Q000652:urine; D004781:Environmental Exposure / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality / Q000652:urine; D012907:Smoking
chemical_list: D002104:Cadmium