Metal Mixtures in Urban and Rural Population in the United States: Evidence from the Multi-Ethnic Study of Atherosclerosis and the Strong Heart Study

Introduction: Natural and anthropogenic sources of metal exposure are different for residents of urban and rural areas. The objectives of this study were to evaluate metal-mixtures and allocate potential environmental sources of different urinary metals, and to compare metal-mixtures in two population-based studies in the United States: the Multi-Ethnic Study of Atherosclerosis (MESA) conducted in 6 urban areas, and the Strong Heart Study (SHS) conducted in 3 rural areas. Methods: We studied 308 White, Chinese, Black and Hispanic adult participants in MESA (2000-2002 examination), and 105 American Indian adult participants in SHS (1998-2003 examination). Participants were selected at random and stratified by site for metal measurements. Nine metals (As, Cd, Mo, Pb, Sb, Se, U, W and Zn) were measured in spot urine specimens by inductively coupled plasma-mass spectrometry. For arsenic, we used the sum of inorganic and methylated species (∑As). We used principal component analysis (PCA), cluster analysis (CA), and linear discriminant analysis (LDA) to evaluate metal-mixtures. We accounted for urine dilution by standardizing metal concentrations by specific gravity. Results: Levels of ∑As, Cd, U, W and Zn were higher in SHS participants as compared with MESA participants. PCA and CA revealed consistent patterns in SHS, suggesting 4 distinct principal components (PC) or clusters (∑As-U-W, Mo-Se, Pb-Sb, Cd-Zn). In MESA, CA showed 2 large clusters (∑As-Mo-Sb-U-W, Cd-Pb-Se-Zn), while PCA showed 4 components (Sb-Se-Zn, Pb-U-W, Cd-Mo, ∑As-Pb). After adjusting for rice intake in MESA, PCA and CA showed more similar findings. LDA indicated that ∑As was the most discriminant variable distinguishing MESA and SHS participants. Conclusions: The ∑As-U-W urinary cluster and PC in SHS might reflect groundwater contamination in rural areas. The Cd-Zn cluster and PC in SHS could reflect common sources from processed meat and interactions in metabolic pathways for those metals. Among our 9 metals, ∑As had the highest discriminant ability to distinguish participants from MESA and SHS, reflecting disproportionate inorganic arsenic exposure in rural tribal communities compared to urban communities around the US

Carotid Intima-Media Thickness and Incident ESRD: The Atherosclerosis Risk in Communities (ARIC) Study

Carotid intima-media thickness has been reported to predict kidney function decline. However, whether carotid intima-media thickness is associated with a hard kidney end point, ESRD, has not been investigated

A Cross-Sectional Study of Tobacco Advertising, Promotion, and Sponsorship in Airports across Europe and the United States

Altres ajuts: The work was supported by grant number 108594 from the Flight Attendant Medical Research Institute (FAMRI) to the Johns Hopkins FAMRI Center of Excellence. The funder had no role in the Int. J. Environ. Res. Public Health 2016, 13, 959 8 of 9 study design, collection, analysis or interpretation of data, writing of the report, nor in the decision to submit the paper for publication.Tobacco advertising, promotion, and sponsorship (TAPS) bans are effective and are increasingly being implemented in a number of venues and countries, yet the state of TAPS in airports and their effect on airport smoking behavior is unknown. The objective of this study was to evaluate the presence of TAPS in airports across Europe and the US, and to begin to examine the relationship between TAPS and smoking behaviors in airports. We used a cross-sectional study design to observe 21 airports in Europe (11) and the US (10). Data collectors observed points of sale for tobacco products, types of products sold, advertisements and promotions, and branding or logos that appeared in the airport. Tobacco products were sold in 95% of all airports, with significantly more sales in Europe than the US. Advertisements appeared mostly in post-security areas; however, airports with advertisements in pre-security areas had significantly more smokers observed outdoors than airports without advertisements in pre-security areas. Tobacco branding appeared in designated smoking rooms as well as on non-tobacco products in duty free shops. TAPS are widespread in airports in Europe and the US and might be associated with outdoor smoking, though further research is needed to better understand any relationship between the two. This study adds to a growing body of research on tobacco control in air transit and related issues. As smoke-free policies advance, they should include comprehensive TAPS bans that extend to airport facilities

Publisher Correction: Copper adparticle enabled selective electrosynthesis of n-propanol.

An amendment to this paper has been published and can be accessed via a link at the top of the paper

Genetic and healthy lifestyle factors in relation to the incidence and prognosis of severe liver disease in the Chinese population

Background: Severe liver disease (SLD), including cirrhosis and liver cancer, constitutes a major disease burden in China. We aimed to examine the association of genetic and healthy lifestyle factors with the incidence and prognosis of SLD. Methods: The study population included 504,009 participants from the prospective China Kadoorie Biobank aged 30–79 years. The individuals were from 10 diverse areas in China without a history of cancer or liver disease at baseline. Cox regression was used to estimate adjusted hazard ratios (HRs) for incident SLD and death after SLD diagnosis associated with healthy lifestyle factors (smoking, alcohol, physical activity, and central adiposity). Additionally, the contribution of genetic risk for hepatitis B virus (HBV, assessed by genetic variants in major histocompatibility complex, class II, DP/DQ [HLA-DP/DQ] genes) was also estimated. Results: Compared with those with 0–1 healthy lifestyle factor, participants with 2, 3, and 4 factors had 12% (HR 0.88 [95% confidence interval [CI] 0.85, 0.92]), 26% (HR 0.74 [95%CI: 0.69, 0.79]), and 44% (HR 0.56 [95%CI: 0.48, 0.65]) lower risks of SLD, respectively. Inverse associations were observed among participants with both low and high genetic risks (HR per 1-point increase 0.83 [95%CI: 0.74, 0.94] and 0.91 [95%CI: 0.82, 1.02], respectively; Pinteraction = 0.51), although with a non-significant trend among those with a high genetic risk. Inverse associations were also observed between healthy lifestyle factors and liver biomarkers regardless of the genetic risk. Despite the limited power, healthy lifestyle factors were associated with a lower risk of death after incident SLD among participants with a low genetic risk (HR 0.59 [95%CI: 0.37, 0.96]). Conclusions: Lifestyle modification may be beneficial in terms of lowering the risk of SLD regardless of the genetic risk. Moreover, it is also important for improving the prognosis of SLD in individuals with a low genetic risk. Future studies are warranted to examine the impact of healthy lifestyles on SLD prognosis, particularly among individuals with a high genetic risk

A wide landscape of morbidity and mortality risk associated with marital status in 0.5 million Chinese men and women: a prospective cohort study

Background: A comprehensive depiction of long-term health impacts of marital status is lacking. Methods: Sex-stratified phenome-wide association analyses (PheWAS) of marital status (living with vs. without a spouse) were performed using baseline (2004–2008) and follow-up information (ICD10-coded events till Dec 31, 2017) from the China Kadoorie Biobank (CKB). We estimated adjusted hazard ratios (aHRs) to evaluate the associations of marital status with morbidity risks of phenome-wide significant diseases or sex-specific top-10 death causes in China documented in 2017. Additionally, the association between marital status and mortality risks among participants with major chronic diseases at baseline was assessed. Findings: During up to 11.1 years of the median follow-up period, 1,946,380 incident health events were recorded among 210,202 men and 302,521 women aged 30–79. Marital status was found to have phenome-wide significant associations with thirteen diseases among men (p < 9.92 × 10−5) and nine diseases among women (p < 9.33 × 10−5), respectively. After adjusting for all disease-specific covariates in the final model, participants living without a spouse showed increased risks of schizophrenia, schizotypal and delusional disorders (aHR [95% CI]: 2.55, [1.83–3.56] for men; 1.49, [1.13–1.97] for women) compared with their counterparts. Additional higher risks in overall mental and behavioural disorder (1.31, 1.13–1.53), cardiovascular disease (1.07, 1.04–1.10) and cancer (1.06, 1.00–1.12) were only observed among men without a spouse, whereas women living without a spouse were at lower risks of developing genitourinary diseases (0.89, 0.85–0.93) and injury & poisoning (0.93, 0.88–0.97). Among 282,810 participants with major chronic diseases at baseline, 39,166 deaths were recorded. Increased mortality risks for those without a spouse were observed in 12 of 21 diseases among male patients and one of 23 among female patients. For patients with any self-reported disease at baseline, compared with those living with a spouse, the aHRs (95% CIs) of mortality risk were 1.29 (1.24–1.34) and 1.04 (1.00–1.07) among men and women without a spouse (pinteraction<0.0001), respectively. Interpretation: Long-term associations of marital status with morbidity and mortality risks are diverse among middle-aged Chinese adults, and the adverse impacts due to living without a spouse are more profound among men. Marital status may be an influential factor for health needs. Funding: The National Natural Science Foundation of China, the Kadoorie Charitable Foundation, the National Key R&D Program of China, the Chinese Ministry of Science and Technology, and the UK Wellcome Trust

Associations of traditional cardiovascular risk factors with 15-year blood pressure change and trajectories in Chinese adults: a prospective cohort study

Objective: How traditional cardiovascular disease (CVD) risk factors are related to long-term blood pressure change (BPC) or trajectories remain unclear. We aimed to examine the independent associations of these factors with 15-year BPC and trajectories in Chinese adults. Methods: We included 15 985 participants who had attended three surveys, including 2004–2008 baseline survey, and 2013–2014 and 2020–2021 resurveys, over 15 years in the China Kadoorie Biobank (CKB). We measured systolic and diastolic blood pressure (SBP and DBP), height, weight, and waist circumference (WC). We asked about the sociodemographic characteristics and lifestyle factors, including smoking, alcohol drinking, intake of fresh vegetables, fruits, and red meat, and physical activity, using a structured questionnaire. We calculated standard deviation (SD), cumulative blood pressure (cumBP), coefficient of variation (CV), and average real variability (ARV) as long-term BPC proxies. We identified blood pressure trajectories using the latent class growth model. Results: Most baseline sociodemographic and lifestyle characteristics were associated with cumBP. After adjusting for other characteristics, the cumSBP (mmHg × year) increased by 116.9 [95% confidence interval (CI): 111.0, 122.7] for every 10 years of age. The differences of cumSBP in heavy drinkers of ≥60 g pure alcohol per day and former drinkers were 86.7 (60.7, 112.6) and 48.9 (23.1, 74.8) compared with less than weekly drinkers. The cumSBP in participants who ate red meat less than weekly was 29.4 (12.0, 46.8) higher than those who ate red meat daily. The corresponding differences of cumSBP were 127.8 (120.7, 134.9) and 70.2 (65.0, 75.3) for BMI per 5 kg/m2 and WC per 10 cm. Most of the findings of other BPC measures by baseline characteristics were similar to the cumBP, but the differences between groups were somewhat weaker. Alcohol drinking was associated with several high-risk trajectories of SBP and DBP. Both BMI and WC were independently associated with all high-risk blood pressure trajectories. Conclusions: Several traditional CVD risk factors were associated with unfavorable long-term BPC or blood pressure trajectories in Chinese adults

Chronic Hepatitis B Virus Infection and Risk of Stroke Types: A Prospective Cohort Study of 500 000 Chinese Adults

BACKGROUND: Stroke is a leading cause of mortality and permanent disability in China, with large and unexplained geographic variations in rates of different stroke types. Chronic hepatitis B virus infection is prevalent among Chinese adults and may play a role in stroke cause. // METHODS: The prospective China Kadoorie Biobank included >500 000 adults aged 30 to 79 years who were recruited from 10 (5 urban and 5 rural) geographically diverse areas of China from 2004 to 2008, with determination of hepatitis B surface antigen (HBsAg) positivity at baseline. During 11 years of follow-up, a total of 59 117 incident stroke cases occurred, including 11 318 intracerebral hemorrhage (ICH), 49 971 ischemic stroke, 995 subarachnoid hemorrhage, and 3036 other/unspecified stroke. Cox regression models were used to estimate adjusted hazard ratios (HRs) for risk of stroke types associated with HBsAg positivity. In a subset of 17 833 participants, liver enzymes and lipids levels were measured and compared by HBsAg status. // RESULTS: Overall, 3.0% of participants were positive for HBsAg. HBsAg positivity was associated with an increased risk of ICH (adjusted HR, 1.29 [95% CI, 1.16–1.44]), similarly for fatal (n=5982; adjusted HR, 1.36 [95% CI, 1.16–1.59]) and nonfatal (n=5336; adjusted HR, 1.23 [95% CI, 1.06–1.44]) ICH. There were no significant associations of HBsAg positivity with risks of ischemic stroke (adjusted HR, 0.97 [95% CI, 0.92–1.03]), subarachnoid hemorrhage (adjusted HR, 0.87 [95% CI, 0.57–1.33]), or other/unspecified stroke (adjusted HR, 1.12 [95% CI, 0.89–1.42]). Compared with HBsAg-negative counterparts, HBsAg-positive individuals had lower lipid and albumin levels and higher liver enzyme levels. After adjustment for liver enzymes and albumin, the association with ICH from HBsAg positivity attenuated to 1.15 (0.90–1.48), suggesting possible mediation by abnormal liver function. // CONCLUSIONS: Among Chinese adults, chronic hepatitis B virus infection is associated with an increased risk of ICH but not other stroke types, which may be mediated through liver dysfunction and altered lipid metabolism

Assessing the associations of metabolic risk factors with risk of cancer in Chinese adults: a prospective study of 0.5 million people

Background: Metabolic risk factors are associated with higher risks of certain cancers in Western populations. Uncertainty remains about the direction, shape, and strength of their associations with specific cancers and their subtypes in China. This thesis aims to investigate the associations of major metabolic risk factors (physical activity [PA], sedentary leisure time [SLT], adiposity, diabetes, and blood glucose) with risks of pancreatic, liver, and colorectal cancer in Chinese adults. Methods: The prospective China Kadoorie Biobank (CKB) recruited 512,713 adults aged 30-79 years from 10 diverse areas of China during 2004-08. After ~10 years of follow-up, there were 26,594 incident cases of cancer, including 796 pancreatic, 2847 liver, and 3024 colorectal cancer cases among 509,892 participants with no prior history of cancer at baseline. Cox regression was used to estimate adjusted hazard ratios (HRs) of specific cancer associated with PA, SLT, adiposity, diabetes, and, among those without previously diagnosed diabetes, with levels of random plasma glucose (RPG). Results: At baseline, the mean (SD) age was 52 (10.7) years and 59% were women. The mean (SD) BMI was 23.7 (3.3) kg/m2, with 33% being overweight (BMI 25-29.9 kg/m2, 29%) or obese (BMI â¥30 kg/m2, 4%), and 5.9% had previously diagnosed (3.1%) or screen-detected (2.8%) diabetes. The mean (SD) total PA and SLT were 21.1 (13.9) metabolic equivalent of tasks (MET)-h/day and 3.0 (1.5) h/day. Total PA was inversely associated with risks of liver and colorectal cancer (HR per 4 MET-h/day: 0.95 [0.93-0.98] and 0.97 [0.94-1.00], respectively) but not with pancreatic cancer, while SLT was positively associated with risk of colorectal cancer (1.13 [1.00-1.26] per 1.5 h/day) but not with pancreatic and liver cancer. For colorectal cancer, the positive association with SLT was stronger for colon than rectal cancer (1.14 [0.98-1.32] vs 1.05 [0.89-1.23]). General (e.g. BMI) and central (e.g. waist circumference [WC]) adiposity measures were positively associated with risk of colorectal cancer (e.g. 1.13 [1.07-1.20] per 5 kg/m2 BMI and 1.17 [1.11-1.22] per 10 cm WC) but not with pancreatic cancer. The positive associations tended to be stronger for colon than rectal cancer (BMI per 5 kg/m2 1.18 [1.10-1.27] vs 1.09 [1.01-1.17]; WC per 10 cm 1.23 [1.16-1.30] vs 1.12 [1.06-1.20]). Liver cancer showed no association with BMI (1.01 [0.93-1.10]) but a positive association with WC (1.08 [1.01-1.15]) after excluding the first five years of follow-up. Diabetes (previously diagnosed or screen-detected) was associated with higher risks of all three cancers (pancreatic 1.62 [1.31-2.00], liver 1.43 [1.26-1.62], colorectal 1.16 [1.02-1.31]), and among participants without previously diagnosed diabetes there were also positive associations of RPG with risks of these cancers, even after exclusion of the first five years of follow-up. Conclusions: In this Chinese population with relatively low levels of adiposity and high levels of physical activity, metabolic risk factors showed different associations with certain common cancers and cancer subtypes, with some consistent with (e.g. diabetes, blood glucose) while others different from (e.g. physical activity, adiposity) previous findings reported in Western populations. </p