美国女性尿液中铅、镉、汞、砷暴露趋势研究：基于NHANES数据库（1999~2020年）

Trends in Urinary Lead, Cadmium, Mercury, and Arsenic Exposure among U.S. Women: An Analysis Based on NHANES Data (1999~2020)

摘要

环境有毒金属污染严重威胁人体健康，而人体尿液是反映综合环境暴露与体内负荷水平的生物标志物。尽管全球已实施多项管控措施，但是敏感人群（如女性）的体内暴露水平如何响应环境政策变化仍缺乏系统研究。基于美国国家健康与营养调查（National Health and Nutrition Examination Survey，NHANES）1999~2020年间共10个周期的数据，开展了一项全国代表性人群的横断面研究。通过加权线性回归模型结合人口统计学因素，定量评估了六岁及以上美国女性人群尿液中铅、镉、汞、砷浓度随时间的变化趋势。在纳入的14698名参与者中，尿液中的铅、镉、汞、砷均呈显著下降趋势，降幅为59.7%、23.1%、68.1%、17.4%。成人尿液中有毒金属普遍较高，尿液中镉、汞、砷浓度是青少年群体的3.5、1.8、1.4倍；超重群体尿液中的铅、镉、汞、砷较肥胖群体高22.5%、8.3%、34.4%、21.9%。美国女性人群尿液中的有毒金属暴露水平显著降低，表明了相关环境监管政策的有效性，也提示需开展敏感人群的干预措施。本研究为有毒金属暴露风险评估、环境健康管理及生态损害相关健康效应研究提供人群流行病学数据支持。

Abstract

Toxic metal pollution in the environment poses a serious threat to human health, and human urine serve as a biomarker reflecting the comprehensive environmental exposure and body burden. Despite the implementation of multiple control measures globally, systematic research on how the exposure levels of sensitive populations (e.g., women) respond to changes in environmental policies is lacking. This population-based cross-sectional study analyzed the urinary data of 10 cycles (1999~2020) from the US National Health and Nutrition Examination Survey (NHANES). We examined temporal trends in urinary concentrations of lead, cadmium, mercury, and arsenic among U.S. females aged 6 years and older using weighted linear regression analyses, in association with sociodemographic factors. Among the 14698 participants included, urinary levels of lead, cadmium, mercury, and arsenic showed significant downward trends, with decreases of 59.7%, 23.1%, 68.1%, and 17.4%. Toxic metal levels were generally higher in adults, being 3.5, 1.8, and 1.4 times higher for cadmium, mercury, and arsenic than in adolescent populations. Urinary lead, cadmium, mercury, and arsenic in overweight individuals were 22.5%, 8.3%, 34.4%, and 21.9% higher than those in obese individuals. Toxic metal exposure levels among U.S. females have declined significantly, indicating the effectiveness of relevant environmental regulatory policies and highlighting the need for targeted interventions in vulnerable populations. This study provides population-based epidemiological evidence for risk assessment of toxic metal exposure, environmental health management, and research on health effects related to ecological damage.

关键词

有毒金属 / 生物监测 / 时间趋势 / 暴露差异 / 女性

Key words

Toxic metals / Biomonitoring / Temporal trends / Exposure disparities / Women

参考文献

[1] Khan S, Naushad M, Lima E C, et al. Global soil pollution by toxic elements: Current status and future perspectives on the risk assessment and remediation strategies — A review[J]. Journal of Hazardous Materials, 2021, 417: 126039.

[2] 黄丹, 王鹏, 陈钦威, 等 . 基于Meta分析的中国农田土壤重金属污染现状[J/OL]. 环境科学学报, 1-14 [2026—01—04].

[3] Agency for Toxic Substances and Disease Registry. Substance priority list[EB/OL]. (2024—11)[2025—11—09]. https://www.atsdr.cdc.gov/programs/substance—priority—list.

[4] Rai P K, Lee S S, Zhang M, et al. Heavy metals in food crops: Health risks, fate, mechanisms, and management[J]. Environment International, 2019, 125: 365-385.

[5] Chowdhury R, Ramond A, O'Keeffe L M, et al. Environmental toxic metal contaminants and risk of cardiovascular disease: Systematic review and meta—analysis[J]. BMJ, 2018, 362.

[6] 曾晨, 郭少娟, 杨立新 . 汞、镉、铅、砷单一和混合暴露的毒性效应及机理研究进展[J]. 环境工程技术学报, 2018, 8(2): 221-230.

[7] Jomova K, Alomar S Y, Nepovimova E, et al. Heavy metals: Toxicity and human health effects[J]. Archives of Toxicology, 2025, 99(1): 153-209.

[8] Cui Y, Bai L, Li C, et al. Assessment of heavy metal contamination levels and health risks in environmental media in the northeast region[J]. Sustainable Cities and Society, 2022, 80: 103796.

[9] Zhang Y, Song Z, Huang S, et al. Global health effects of future atmospheric mercury emissions[J]. Nature Communications, 2021, 12: 3035.

[10] Wu X, Cobbina S J, Mao G, et al. A review of toxicity and mechanisms of individual and mixtures of heavy metals in the environment[J]. Environmental Science and Pollution Research, 2016, 23(9): 8244-8259.

[11] Järup L. Hazards of heavy metal contamination[J]. British Medical Bulletin, 2003, 68: 167-182.

[12] 蔡嘉旖, 张文丽 . 人群暴露环境镉污染与健康危害的流行病学研究进展[J]. 环境卫生学杂志, 2019, 9(6): 621-627.

[13] Stanfield Z, Setzer R W, Hull V, et al. Characterizing chemical exposure trends from NHANES urinary biomonitoring data[J]. Environmental Health Perspectives, 2024, 132(1): 17009.

[14] Yilmaz B, Terekeci H, Sandal S, et al. Endocrine disrupting chemicals: Exposure, effects on human health, mechanism of action, models for testing and strategies for prevention[J]. Reviews in Endocrine and Metabolic Disorders, 2020, 21(1): 127-147.

[15] Diamanti—Kandarakis E, Bourguignon J P, Giudice L C, et al. Endocrine—disrupting chemicals: An endocrine society scientific statement[J]. Endocrine Reviews, 2009, 30(4): 293-342.

[16] Colborn T, vom Saal F S, Soto A M . Developmental effects of endocrine—disrupting chemicals in wildlife and humans[J]. Environmental Health Perspectives, 1993, 101(5): 378-384.

[17] Wang B, Du Y . Cadmium and its neurotoxic effects[J]. Oxidative Medicine and Cellular Longevity, 2013, 2013: 898034.

[18] Scimeca M, Giacobbi E, Bonfiglio R, et al. Lead bioaccumulation in human breast cancer tissue is associated with DNA instability and cell death resistance[J]. Cell Death Discovery, 2025, 11(1): 383.

[19] da Costa C S, Oliveira T F, Freitas—Lima L C, et al. Subacute cadmium exposure disrupts the hypothalamic—pituitary—gonadal axis, leading to polycystic ovarian syndrome and premature ovarian failure features in female rats[J]. Environmental Pollution, 2021, 269: 116154.

[20] Edwards T M, Myers J P . Environmental exposures and gene regulation in disease etiology[J]. Environmental Health Perspectives, 2007, 115(9): 1264-1270.

[21] 徐培娟, 古桂雄 . 环境镉对健康及生殖的危害[J]. 国外医学, 妇幼保健分册, 2004(1): 35-37.

[22] Ettinger A S, Egan K B, Homa D M, et al. Blood lead levels in U.S. women of childbearing age, 1976—2016[J]. Environmental Health Perspectives, 2020, 128(1): 17012.

[23] Egan K B, Cornwell C R, Courtney J G, et al. Blood lead levels in U.S. children ages 1—11 years, 1976—2016[J]. Environmental Health Perspectives, 2021, 129(3): 37003.

[24] Knox K E, Schwarzman M R, Rudel R A, et al. Trends in NHANES biomonitored exposures in california and the United States following enactment of california’s proposition 65[J]. Environmental Health Perspectives, 2024, 132(10): 107007.

[25] Pirkle J L, Osterloh J, Needham L L, et al. National exposure measurements for decisions to protect public health from environmental exposures[J]. International Journal of Hygiene and Environmental Health, 2005, 208: 1-5.

[26] Centers for Disease Control and Prevention. NHANES 2011—2012 laboratory methods[EB/OL]. (2019—11) [2025—06—11]. https://wwwn.cdc.gov/nchs/nhanes/continuousnhanes/labmethods.aspx?BeginYear=2011.

[27] Zhu H, Zhang H, Lu K, et al. Chlorinated organophosphate flame retardants impair the lung function via the IL—6/JAK/STAT signaling pathway[J]. Environmental Science & Technology, 2022, 56(24): 17858-17869.

[28] Huang Y S, Shi H Z, Huang X, et al. Urinary concentrations of organophosphate flame—retardant metabolites in the US population[J]. JAMA Network Open, 2024, 7(9): e2435484.

[29] Luo K, Zhang R, Aimuzi R, et al. Exposure to organophosphate esters and metabolic syndrome in adults[J]. Environment International, 2020, 143: 105941.

[30] Pirkle J L, Brody D J, Gunter E W, et al. The decline in blood lead levels in the United States: The National Health and Nutrition Examination Surveys (NHANES)[J]. JAMA, 1994, 272(4): 284-291.

[31] Muntner P, Menke A, DeSalvo K B, et al. Continued decline in blood lead levels among adults in the United States: The National Health and Nutrition Examination Surveys[J]. Archives of Internal Medicine, 2005, 165(18): 2155-2161.

[32] Environmental Protection Agency . Lead and copper rule revisions white paper[EB/OL]. (2016)[2025—12—11]. https://www.epa.gov/sites/production/files/2016—10/documents/.

[33] Centers for Disease Control and Prevention. Smoking and tobacco use[EB/OL]. (2024)[2025—12—19]. https://www.cdc.gov/tobacco/index.html.

[34] 蒋梦珂, 陈琦, 丁震, 等 . 探索尿镉作为人群镉暴露生物标志物的影响因素[J]. 环境与职业医学, 2021, 38(10): 1057-1062.

[35] Tellez—Plaza M, Navas—Acien A, Caldwell K L, et al. Reduction in cadmium exposure in the United States population, 1988—2008: The contribution of declining smoking rates[J]. Environmental Health Perspectives, 2012, 120(2): 204-209.

[36] Food and Drug Administration . FDA issues updated advice about eating fish[EB/OL]. (2021)[2025—12—19]. https://www.fda.gov/food/hfp—constituent—updates/fda—issues—updated—advice—about—eating—fish.

[37] Environmental Protection Agency . Mercury and air toxics standards[EB/OL]. (2025) [2025—12—19]. https://www.epa.gov/stationary—sources—air—pollution/mercury—and—air—toxics—standards.

[38] Environmental Protection Agency . National primary drinking water regulations; Arsenic and clarifications to compliance and new source contaminants monitoring[EB/OL]. (2001—01)[2025—05—19]. https://www.federalregister.gov/documents/2001/01/22/01—1668/national—primary—drinking—water—regulations—arsenic—and—clarifications—to—compliance—and—new—source.

[39] Nigra A E, Sanchez T R, Nachman K E, et al. The effect of the Environmental Protection Agency maximum contaminant level on arsenic exposure in the USA from 2003 to 2014: An analysis of the National Health and Nutrition Examination Survey (NHANES)[J]. The Lancet Public Health, 2017, 2(11): e513-e521.

[40] Moya J, Bearer C F, Etzel R A . Children’s behavior and physiology and how it affects exposure to environmental contaminants: Pediatrics[J]. Pediatrics, 2004, 113(4): 996-1006.

[41] Hu H, Shih R, Rothenberg S, et al. The epidemiology of lead toxicity in adults: Measuring dose and consideration of other methodologic issues[J]. Environmental Health Perspectives, 2007, 115(3): 455-462.

[42] Zhou Y, Addai F P, Zhang X, et al. Heavy metal—induced lipogenic gene aberration, lipid dysregulation and obesogenic effect: A review[J]. Environmental Chemistry Letters, 2022, 20(3): 1611-1643.

[43] Berglund M, Lindberg A L, Rahman M, et al. Gender and age differences in mixed metal exposure and urinary excretion[J]. Environmental Research, 2011, 111(8): 1271-1279.

[44] Love D C, Thorne—Lyman A L, Conrad Z, et al. Affordability influences nutritional quality of seafood consumption among income and race/ethnicity groups in the United States[J]. The American Journal of Clinical Nutrition, 2022, 116(2): 415-425.