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Biomonitoring Exposures Study (BEST): Results for Urinary and Blood Metals Presentation to the Scientific Guidance Panel Meeting November 8, 2018 Jennifer Mann, Ph.D. Research Scientist IV Center for Healthy Communities California Department of Public Health 1

Biomonitoring Exposures Study (BEST): Results for …...Biomonitoring Exposures Study (BEST): Results for Urinary and Blood Metals Presentation to the Scientific Guidance Panel Meeting

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Page 1: Biomonitoring Exposures Study (BEST): Results for …...Biomonitoring Exposures Study (BEST): Results for Urinary and Blood Metals Presentation to the Scientific Guidance Panel Meeting

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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Page 5: Biomonitoring Exposures Study (BEST): Results for …...Biomonitoring Exposures Study (BEST): Results for Urinary and Blood Metals Presentation to the Scientific Guidance Panel Meeting

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)

6

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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)

7

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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)

8

Page 9: Biomonitoring Exposures Study (BEST): Results for …...Biomonitoring Exposures Study (BEST): Results for Urinary and Blood Metals Presentation to the Scientific Guidance Panel Meeting

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)

9

Page 10: Biomonitoring Exposures Study (BEST): Results for …...Biomonitoring Exposures Study (BEST): Results for Urinary and Blood Metals Presentation to the Scientific Guidance Panel Meeting

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)

10

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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)

11

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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)

12

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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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