Cadmium levels in urine and mortality among U.S. adults

Environ Health Perspect. 2009 Feb;117(2):190-6. doi: 10.1289/ehp.11236. Epub 2008 Sep 3.


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.

Keywords: NHANES III; cadmium exposure; cancer; cardiovascular disease; epidemiology; human; mortality.

MeSH terms

  • Adult
  • Cadmium / adverse effects*
  • Cadmium / urine*
  • Cardiovascular Diseases / mortality
  • Cardiovascular Diseases / urine
  • Confidence Intervals
  • Coronary Disease / mortality
  • Coronary Disease / urine
  • Environmental Exposure / adverse effects*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neoplasms / mortality
  • Neoplasms / urine
  • Smoking


  • Cadmium