biomonitoring exposures study (best): results for …...biomonitoring exposures study (best):...
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Biomonitoring Exposures Study (BEST): Results for Urinary and Blood Metals
Presentation to the Scientific Guidance Panel MeetingNovember 8, 2018
Jennifer Mann, Ph.D.Research Scientist IVCenter for Healthy CommunitiesCalifornia Department of Public Health
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HISTORY Sample of adult Kaiser Permanente members
Sacramento ■ Merced ■ Yolo San Joaquin ■ Madera Stanislaus ■ Fresno
Pilot (2011-2012) N=112 participants 110 blood samples; 108 urine samples
Expanded (2013) Oversampled Hispanics; Asian/Pacific Islanders (API) N=315 blood samples; 218 urine samples
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CHARACTERISTICS OF PARTICIPANTS
Characteristic Pilot Expanded
Age (mean/sd)* 56.3(15.2) 48.2 (17.2)
% Male 55 47
% Rural* 8.3 32
% Prefer Spanish language* 3.6 17
Race/Ethnicity *% Black% API% Hispanic% White
29181836
13334114
% High school graduates 89.5 90.6
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BIOMONITORING EXPOSURES STUDY
Part I:
Geometric Mean levels in Pilot and Expanded phases of BEST
Comparison with National Health and Nutrition Examination Survey (NHANES)
Part II
Predictors of urinary and blood metal concentrations in Expanded BEST
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METALS ANALYZED
Urinary Metals Arsenic
Cadmium
Mercury
Cobalt
Manganese
Molybdenum
Thallium
Tungsten
Uranium
Blood Metals Cadmium
Lead
Manganese
Mercury
Pilot and Expanded BESTExpanded BEST
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Total Urinary Arsenic (µg/L)
0
2
4
6
8
10
12
14
16
Pilot (2011-12) NHANES (2011-12) Expanded (2013) NHANES (2013-14)
Geo
met
ric
Mea
n (9
5% C
I)
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Urinary Cadmium (creatinine-adjusted) µg/g
0.00
0.05
0.10
0.15
0.20
0.25
0.30
0.35
0.40
Pilot (2011-12) NHANES (2011-12) Expanded (2013) NHANES (2013-14)
Geo
met
ric
Mea
n (9
5% C
I)
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Urinary Mercury (µg/L)
0.00
0.05
0.10
0.15
0.20
0.25
0.30
0.35
0.40
0.45
Pilot (2011-12) NHANES (2011-12) Expanded (2013) NHANES (2013-14)
Geo
met
ric
Mea
n (9
5% C
I)
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Blood Cadmium (µg/L)
0.00
0.05
0.10
0.15
0.20
0.25
0.30
0.35
0.40
Pilot (2011-12) NHANES (2011-12) Expanded (2013) NHANES (2013-14)
Geo
met
ric
Mea
n(9
5% C
I)
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Blood Lead (µg/dL)
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
Pilot (2011-12) NHANES (2011-12) Expanded (2013) NHANES (2013-14)
Geo
met
ric
Mea
n (9
5% C
I)
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Blood Mercury (µg/L)
0
0.2
0.4
0.6
0.8
1
1.2
Pilot (2011-12) NHANES (2011-12) Expanded (2013) NHANES (2013-14)
Geo
met
ric
Mea
n (
95%
CI)
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Blood Manganese (µg/L)
0
2
4
6
8
10
12
Pilot (2011-12) NHANES (2011-12) Expanded (2013) NHANES (2013-14)
Geo
met
ric
Mea
n (9
5% C
I)
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PREDICTION MODELS FOR URINARY AND BLOOD METALSEXPANDED BEST
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EXPANDED BEST: URINARY METALS (N=218)
MetalDetectionFrequency
GM#
Expanded BEST(µg/L)
GMNHANES2013-2014
(µg/L)
Arsenic 100% 11.2* 7.58
Cadmium^ 93% 0.24* 0.18
Cobalt 99% 0.19 0.37*
Manganese 60% ND ND
Mercury 94% 0.20 0.27*
Molybdenum 100% 46.7* 30.8
Thallium 99% 0.18* 0.14
Tungsten 96% 0.08* 0.05
Uranium 86% 0.008* 0.005
#: GM=Geometric Mean; ^creatinine-adjusted (µg/g) * p<.05
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BLOOD METALS (N=315)
DetectionFrequency
Expanded BESTGM
NHANES 13-14GM
Cadmium (µg/L) 100 0.27 0.30
Lead (µg/dL) 100 0.84 0.97*
Manganese (µg/L) 100 9.55 9.27
Mercury (µg/L) 99.7 0.83 0.81
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VARIABLES IN PREDICTION MODELS
Same variables in every model
Sex
Age Category (10-year)
Race/Ethnicity
Asian/Pacific Islander
Hispanic
African-American
White (ref)
Diet: grains, fresh and canned fish, vegetables and fruit
Time in U.S.
Educational Level
Smoking Status
Rural residence
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STATISTICAL ANALYSIS
Percent increase or decrease Relative to reference group (categorical variables)
1-day/wk increase in consumption (diet)
Test for trend: Age group
Smoking status
Time in U.S.
Educational level
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EXPLANATORY POWER OF MODELS (R2) (%)
URINE(N=218)
BLOOD(N=315)
Total Arsenic 17 ---
Cadmium (creatinine-adjusted) 52 36Cobalt 16 ---Lead --- 42Manganese Low DF 23Mercury 19 35Molybdenum 19 ---Thallium 18 ---Tungsten 17 ---Uranium 22 ---
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RACE/ETHNICITY % Difference (95% CI)
Metal API African-American
Hispanic
Blood Mercury 63% (13 to 136) -14% (-14 to -3)
Urinary Mercury 145% (134 to 350) 193% (41 to 507) 104% (108 to 286)
Total Arsenic 76% (7 to 188) 102% (12 to 265)
Molybdenum 70% (2 to 185)
Tungsten 130% (16 to 345)
Reference group was white participants. Adjusted for sex, age group, education level, time in U.S., and smoking status. All items listed are statistically significant (p<.05).
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DIET% Difference (95% CI)
Metal Fresh Fish Canned Fish Fresh Fruit Canned Fruit
Blood Mercury 23% (13 to 34) 17% (4 to 32)
Total Arsenic 12% (0.4 to 26)
Thallium -12% (-22 to 0) 19% (1 to 39)
Cobalt 21% (5 to 64)Adjusted for sex, age group, race/ethnicity, education level, time in U.S., and smoking status. All items listed are statistically significant (p<.05)
• Relative concentration for an increase of 1 day/week
• Grains, fresh and canned vegetables and fresh fruit were not associated with increased levels of any of the metals in Expanded BEST
• The BEST study did not include a specific question about rice consumption20
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GENERATION/TIME IN U.S.
Born in U.S. (Y/N). (Ref)
If not born in U.S. , years lived here:
>=25 years
16-25
11-15 years
≤10 years
Uranium levels decrease with time in U.S. (test for trend, p=0.05)
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URBAN OR RURAL ADDRESS
Geocoded as rural or urban Census definition: based on population density and/or land use designations
Possible proxy for private well water use
Participants from rural areas were higher in : Molybdenum 44% (8 to 92) p=0.04
Thallium 23% (-3 to 55 ) p=0.09
Uranium 60% (7 to 141) p=0.02
Blood Manganese 7% (0 to 15) p=0.06
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SUMMARY / CONCLUSION
Many of the metals added to the urinary panel for Expanded BEST were higher than in NHANES
Elevated metal concentration in non-white groups even after adjustment for other predictors. Asian/PI special group of interest One motivation for Asian/Pacific Islander Community Exposures (ACE)
Project
Elevated levels of urinary molybdenum, thallium, uranium, and blood manganese in rural participants Reason for higher levels still need to be explored
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BEST: WORKS IN PROGRESS
Journal articles: Urinary and blood metals Perfluorinated compounds
New student project
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ACKNOWLEDGEMENTS
Kaiser Permanente Division of Research, Northern California Stephen Van Den Eeden Jun Shan Amethyst Leimpeter
All Biomonitoring California staff who contributed to Pilot and Expanded BEST
BEST was funded under CDC cooperative agreement U88EH000481
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