Association between asthma, chronic bronchitis, emphysema, chronic obstructive pulmonary disease, and lung cancer in the US population.

Lung cancer is one of the primary causes of death with poor life expectancy after diagnosis. History of past respiratory diseases such as asthma, chronic obstructive lung disease (COPD), emphysema, and chronic bronchitis can increase the risk of lung cancer. Very few studies are available to simultaneously assess multiple respiratory diseases and lung cancer. The objective of this study was to investigate correlations between asthma, emphysema, chronic bronchitis, and chronic obstructive lung disease with lung cancer in the US adult population. This was a cross-sectional study using data from a total of 23,523 adult participants from the National Health Examination and Nutrition Survey (NHANES) datasets for seven cycles ranging from 2003-2004 to 2015-2016. To analyze the data, specialized weighted complex survey logit regressions were conducted. Linear logit regression models using only main-effects were constructed first to assess the correlation between the selected demographic and lifestyle variables and asthma, emphysema, chronic bronchitis, and COPD. A second set of linear, main-effects logit regression models were constructed to examine the correlation between lung cancer and asthma, emphysema, chronic bronchitis, COPD when corrected for the selected covariates. The study identified positive correlations between emphysema, chronic bronchitis, COPD, and lung cancer. No correlation between asthma and lung cancer was established. Of the covariates studied, race/ethnicity, marital status, highest educational level, age, family income to poverty ratio, and lifetime smoking were also found to be correlated with the presence of lung cancer. Correlations between the covariates gender, body mass index, alcohol consumption, and country of birth and lung cancer were not found. The study established statistically significant correlations between lung cancer and the lung diseases emphysema, chronic bronchitis, and COPD. The lack of association between asthma and lung cancer may arise from the timeline of diagnosis asthma or type of lung cancer. The study also established significant correlations between lung cancer and several of the covariates included in the analysis. It also established correlations between the covariates and the lung diseases asthma, emphysema, chronic bronchitis, and COPD.

Arsenic exposure and prevalence of human papillomavirus in the US male population.

Arsenic is a known carcinogen and is naturally available in earth's crust. Inorganic arsenic is an environmental pollutant with immunosuppressive properties. Human papillomavirus (HPV) is considered one of the most common sexually transmitted diseases in the United States. HPV is linked to several types of cancers in males, including oral, anal, and penile cancer. However, limited information is available on the effect of arsenic on HPV in males. The purpose of this study was to examine the association of urinary arsenic species (speciated and total) and the prevalence of HPV infection in the male population. HPV prevalence in males was analyzed using the 2013-2014 and 2015-2016 National Health and Nutrition Examination Survey (NHANES) dataset. Logistic regression analysis was used to examine associations of seven types of urinary arsenic species (arsenous acid, arsenic acid, arsenobetaine, arsenocholine, dimethylarsinic acid (DMA), monomethylarsonic acid (MMA), total arsenic acid) with HPV risk for male participants aged 18-59 years (N = 1516). Demographic characteristics were included in the logistic regression model for each arsenic variable. All statistical analyses were conducted by using the software R (version 4.2.0). Increasing DMA was positively associated with the prevalence of low-risk HPV (odds ratio (OR): 1.075, 95% confidence interval (CI): 1.025, 1.128) in addition to the sum of total toxic arsenic species (TUA1) including arsenous acid, arsenic acid, DMA, and MMA (OR: 1.068, 95% CI: 1.022, 1.116). High-risk HPV strains were found to be positively associated with arsenic acid (OR: 1.806, 95% CI: 1.134, 2.876) and total arsenic minus the sum of the two organic arsenic species arsenobetaine and arsenocholine (TUA2) at quartile 3 (Q3) level (OR: 1.523, 95% CI: 1.102, 2.103). The logistic regression models also showed that race and marital status were significant factors related to high-risk HPV. Our study reported that DMA and TUA1 are associated with low-risk HPV and arsenic acid is associated with high-risk HPV infections in males. Future research is required to confirm or refute this finding.

Urinary polycyclic aromatic hydrocarbon, arsenic, and metal exposure and correlation with emphysema in smokers.

PURPOSE: Environmental exposure to metals and chemicals can increase the risk of acute and chronic pulmonary diseases in the human population. This study aimed to analyze seven forms of polycyclic aromatic hydrocarbons (PAHs), seven types of arsenic species, fourteen types of urinary metals including antimony, barium, cadmium, cesium, cobalt, lead, manganese, mercury, molybdenum, strontium, thallium, tin, tungsten, uranium, and the link with emphysema in the US adult cigarette smoking population. METHODS: A specialized weighted complex survey design analysis using 2011-2016 National Health and Nutrition Examination Survey (NHANES) datasets was conducted. Multivariate logistic regression models were used to assess the association between urinary metals, arsenic, PAHs, and emphysema in adult smokers. R software was used to conduct the statistical analysis. RESULTS: All 4th quantile concentrations of PAHs, including 1-hydroxynaphthalene, 2-hydroxynaphthalene, 3-hydroxyfluorene, 2-hydroxyfluorene, 1-hydroxypyrene, 1-hydroxyphenanthrene, and 2 & 3-hydroxyphenanthrene, were significantly associated with emphysema in smokers. The 3rd quantile of 1-hydroxypyrene were also associated with increased odds of emphysema in smokers. Among arsenic and metals, the 4th quantile of cadmium was associated with an increased odds of emphysema in smokers. The 3rd quantile of dimethylarsinic acid (DMA) and 4th quantile of mercury were found to have inverse relationships with emphysema in smokers. Several demographic factors had significant associations with emphysema in smokers. CONCLUSION: Urinary PAHs and cadmium were associated with increased odds of emphysema in smokers. DMA and mercury had an inverse association with emphysema in smokers.

Urinary metals, arsenic, and polycyclic aromatic hydrocarbon exposure and risk of chronic bronchitis in the US adult population.

Metals, arsenic, and polycyclic aromatic hydrocarbons (PAHs) have all been linked to respiratory diseases. Chronic bronchitis, which is a form of chronic obstructive pulmonary disease (COPD), is a major public health concern and source of morbidity and mortality in the US. The purpose of this study was to analyze the correlation of 14 urinary metals (antimony, barium, cadmium, cesium, cobalt, lead, manganese, mercury, molybdenum, strontium, thallium, tin, tungsten, uranium), seven species of arsenic, and seven forms of polycyclic aromatic hydrocarbon (PAH) concentrations and chronic bronchitis in the US population. A cross-sectional analysis using three datasets from the National Health and Nutrition Examination Survey (NHANES) between 2011 and 2016 in adults, aged 20 years and older. Chronic bronchitis was determined using a self-questionnaire from the NHANES dataset. A specialized weighted complex survey design analysis package was used to analyze NHANES data. Multivariate logistic regression models were used to determine the correlation between urinary metals, arsenic, PAHs, and chronic bronchitis. Models were adjusted for lifestyle and demographic factors. A total of 4186 participants were analyzed; 49.8% were female and 40.5% were non-Hispanic White. All seven types of PAHs showed a positive association with chronic bronchitis (1-hydroxynaphthalene odds ratio (OR): 1.559, 95% confidence interval (CI): 1.271-1.912; 2-hydroxynaphthalene OR: 2.498, 95% CI: 1.524-4.095; 3-hydroxyfluorene OR: 2.752, 95% CI: 2.100-3.608; 2-hydroxyfluorene OR: 3.461, 95% CI: 2.438-4.914; 1-hydroxyphenanthrene OR: 2.442, 95% CI: 1.515-3.937; 1-hydroxypyrene OR: 2.828, 95% CI: 1.728-4.629; 2 & 3-hydroxyphenanthrene OR: 3.690, 95% CI: 2.309-5.896). Of the metals, only urinary cadmium showed a statistically significant positive association (OR: 2.435, 95% CI: 1.401-4.235) with chronic bronchitis. No other metals or arsenic were correlated with chronic bronchitis. Seven forms of urinary PAHs, cadmium, and several demographic factors were associated with chronic bronchitis.

Avalanche Preparedness and Accident Analysis Among Backcountry Skier, Sidecountry, and Snowmobile Fatalities in the United States: 2009 to 2019.

INTRODUCTION: While avalanche fatalities have remained relatively steady per year, data suggest a possible increase in sidecountry use and snowmobile fatalities. Limited information is known regarding the accident details and preparedness among different groups of backcountry users including snowmobiles, sidecountry, and backcountry skiers, and what specific factors could contribute to their fatalities. METHODS: Avalanche fatality reports covering all US states posted by the Colorado Avalanche Information Center available online for 10 seasons (2009-2010 through 2018-2019 seasons) were analyzed for group size, specific equipment carried, burial depth, burial time, and other details. Only reports in the 3 following categories were included in the analysis: backcountry ski/snowboard, sidecountry ski/snowboard, and snowmobile/snowbike. These aspects were compared among the 3 tourer types using statistical analyses (ANOVA). RESULTS: Two hundred and five fatalities were analyzed (n=32 sidecountry, n=91 skier/snowboard, n=82 snowmobile/snowbike). Using 2 preparedness scores, the ski/snowboard group had the greatest distribution of high scores when evaluated by equipment carried and group size, with significant differences per group (P<0.01). Of the fatalities that were buried, burial time was related to the tourer group (P=0.04), with the ski/snowboard group having the highest proportion of burials <15 min. Burial depth was significantly different among the 3 tourer groups, with snowmobiles buried the deepest on average (P<0.01). CONCLUSIONS: Despite limited data available on fatalities, an analysis of preparedness suggests that backcountry skiers and snowboarders are more prepared for avalanche accidents compared to snowmobiles and sidecountry users when evaluated by equipment carried and group size.

Association between environmental toxic metals, arsenic and polycyclic aromatic hydrocarbons and chronic obstructive pulmonary disease in the US adult population.

Associations between environmental metals and chemicals and adverse human health effects have emerged recently, but the links among environmental metals and respiratory diseases are less studied. The aim of this study was to assess 14 urinary metals (cadmium, barium, cobalt, molybdenum, mercury, cesium, manganese, antimony, lead, tin, strontium, tungsten, thallium, and uranium), seven species of arsenic (arsenous acid, arsenic acid, arsenobetaine, arsenocholine, dimethylarsinic acid, monomethylarsonic acid, and total arsenic) and seven polycyclic aromatic hydrocarbon (PAH) (1-hydroxynaphthalene, 2-hydroxynaphthalene, 3-hydroxyfluorene, 2-hydroxyfluorene, 1-hydroxyphenanthrene, 1-hydroxypyrene, 2 & 3-hydroxyphenanthrene) compounds' concentrations in urine and the correlation with chronic obstructive pulmonary disease (COPD) in the adult US population. A cross-sectional analysis using the 2013-2014 and 2015-2016 National Health and Nutrition Examination Survey (NHANES) dataset was conducted. Self-questionnaires related to COPD criteria were used to identify the COPD cases. The correlation between urinary metals and PAH compounds and COPD was calculated. The total study population analyzed included 2885 adults aged 20 years and older. Seven types of urinary PAHs including 1-hydroxynaphthalene [odds ratio (OR): 1.832, 95% confidence interval (CI): 1.210, 2.775], 2-hydroxynaphthalene [OR: 3.361, 95% CI: 1.519, 7.440], 3-hydroxyfluorene [OR: 2.641, 95% CI: 1.381, 5.053], 2-hydroxyfluorene [OR: 3.628, 95% CI: 1.754, 7.506], 1-hydroxyphenanthrene [OR: 2.864, 95% CI: 1.307, 6.277], 1-hydroxypyrene [OR: 4.949, 95% CI: 2.540, 9.643] and 2 & 3-hydroxyphenanthrene [OR: 3.487, 95% CI: 1.382, 8.795] were positively associated with COPD. Urinary cadmium [OR: 12.382, 95% CI: 4.459, 34.383] and tin [OR: 1.743, 95% CI: 1.189, 2.555] showed positive associations with increased odds of COPD. The other types of urinary metals were not associated with COPD. The study observed that urinary PAHs, cadmium, and tin are significantly associated with COPD.

Urinary Metals, Arsenic, and Polycyclic Aromatic Hydrocarbon Exposure and Risk of Self-reported Emphysema in the US Adult Population.

PURPOSE: Metal and chemical exposure can cause acute and chronic respiratory diseases in humans. The purpose of this analysis was to analyze 14 types of urinary metals including mercury, uranium, tin, lead, antimony, barium, cadmium, cobalt, cesium, molybdenum, manganese, strontium, thallium, tungsten, six types of speciated arsenic, total arsenic and seven forms of polycyclic aromatic hydrocarbons (PAHs), and the link with self-reported emphysema in the US adult population. METHODS: A cross-sectional analysis using the 2011-2012, 2013-2014 and 2015-2016 National Health and Nutrition Examination Survey datasets was conducted. A specialized weighted complex survey design analysis package was used in analyzing the data. Multivariate logistic regression models were used to assess the association between urinary metals, arsenic, and PAHs and self-reported emphysema among all participants and among non-smokers only. Models were adjusted for lifestyle and demographic factors. RESULTS: A total of 4,181 adults were analyzed. 1-Hydroxynaphthalene, 2-hydroxynaphthalene, 3-hydroxyfluorene, 2-hydroxyfluorene, 1-hydroxypyrene, and 2 & 3-hydroxyphenanthrene were positively associated with self-reported emphysema. Positive associations were also observed in cadmium and cesium with self-reported emphysema. Among non-smokers, quantiles among 2-hydroxynaphthalene, arsenocholine, total urinary arsenic, cesium, and tin were associated with increased odds of self-reported emphysema. Quantiles among 1-hydroxyphenanthrene, cadmium, manganese, lead, antimony, thallium, and tungsten were associated with an inverse relationship with self-reported emphysema in non-smokers. CONCLUSION: The study determined that six types of urinary PAHs, cadmium, and cesium are positively associated with self-reported emphysema. Certain quantiles of 2-hydroxynaphthalene, arsenocholine, total urinary arsenic, cesium, and tin are positively associated with self-reported emphysema among non-smokers.

Environmental exposure to metals and the risk of high blood pressure: a cross-sectional study from NHANES 2015-2016.

Exposure to metal pollution can be caused from inhalation, ingestion, or absorption from air, water, or food. Chronic exposure to trace amounts of metals can lead to high blood pressure, or hypertension, and other chronic diseases. The rationale of our study was to determine if there was a correlation between nineteen forms of urinary metal concentrations and high blood pressure, defined as ≥ 130 mm Hg systolic or ≥ 80 mm Hg diastolic, in the adult US population, to understand the possible impacts of metal exposure on humans. Five types of urinary arsenic species and fourteen types of urinary metals were studied to examine their correlation with high blood pressure. We used the dataset from the 2015-2016 National Health and Nutrition Examination Survey (NHANES) for the study. A specialized complex survey design analysis package was used in analyzing the NHANES data. We used pairwise t tests and the logit regression models to study the correlation between urinary arsenic (five types) and urinary metal (fourteen types) concentrations and high blood pressure. The total study population analyzed included 4037 adults aged 20 years and older, of whom 57.9% of males and 51.7% of females had high blood pressure. Urinary arsenous acid (OR: 2.053, 95% CI: 1.045, 4.035), tin (OR: 1.983, 95% CI: 1.169, 3.364), and cesium (OR: 2.176, 95% CI: 1.013, 4.675) were associated with increased odds of high blood pressure. The other four types of urinary arsenic and twelve types of urinary metals were not associated with high blood pressure. Our results determined that exposure to environmental metals such as arsenous acid, tin, and cesium can be associated with high blood pressure. Further investigation is suggested to support our findings.

Association of urinary arsenic and sleep disorder in the US population: NHANES 2015-2016.

Arsenic is a known carcinogen and neurotoxin and is found in the natural earth crust. Arsenic exposure can develop depression, memory dysfunction, and neurodegenerative disorder. The mechanism of arsenic toxicity on the nervous system is not known. There is a lack of research on the association between arsenic exposure and sleep disturbance in humans. This study aims to investigate the relationship between six types of urinary speciated arsenic exposure and sleep disturbance in adults from the general population using the National Health and Nutrition Examination Survey (NHANES) 2015-2016 dataset. Sleep disturbance was measured using self-reported questionnaires, asking participants if they had ever told a doctor they had trouble sleeping. We utilized multivariate logistic regression analysis using complex survey procedures to examine the association between six types of urinary arsenic concentration and trouble sleeping. The total sample included 1,611 adults who were 20 years and older. Of the study participants, 30.0% had trouble sleeping. Compared to individuals with urinary arsenous acid below the lower level of detection (LLOD), those with urinary arsenous acid at or above the detection limit had lower odds of trouble sleeping [odds ratio: 0.72 (95% confidence interval 0.51-1.00, p-value: 0.05)]. The other five types of urinary speciated arsenic studied (arsenic acid, arsenobetaine, arsenocholine, dimethylarsinic acid, monomethylarsonic acid) were not associated with a sleep disorder. More studies are required to confirm or refute these findings.

Association of chronic kidney disease with exposure to polycyclic aromatic hydrocarbons in the US population.

Polycyclic aromatic hydrocarbons (PAHs) are environmental pollutants formed from the incomplete combustion of carbon-containing products. Exposure can occur through ingestion or inhalation and has been linked to depression, stroke, liver disease, asthma, diabetes, heart failure, and cancer. Few studies have investigated the association between exposure to PAHs and chronic kidney disease (CKD) in humans. This study aims to investigate the association between seven urinary PAH concentrations (1-hydroxynaphthalene, 2-hydroxynaphthalene, 3-hydroxyfluorene 2-hydroxyfluorene, 1-hydroxyphenanthrene, 1-hydroxypyrene, and 2 & 3-hydroxyphenanthrene) and CKD in the US adult population. A cross-sectional analysis using the 2015-2016 National Health and Nutrition Examination Survey (NHANES) dataset was conducted. CKD was defined with estimated glomerular filtration rate (eGFR) and albumin to creatinine ratio (ACR). Participants with an eGFR < 60 ml/min/1.73m2 or ACR > 30 mg/gm were considered to have CKD. A specialized complex survey design analysis package using R version 4.0.3 was used in the data analysis. Multivariate logistic regression was used to study the correlation between seven forms of urinary PAH concentrations and CKD associated with abnormal eGFR or ACR. The models were adjusted for lifestyle and demographic factors. The study included a total of 4117 adults aged ≥ 20 years, with 49.6% males and 50.4% females. Urinary 2-hydroxynaphthalene (OR: 1.600, 95% CI: 1.141, 2.243) was significantly associated with an increased odds of CKD; the other six forms of urinary PAHs were not associated with CKD. Non-Hispanic Black (OR: 1.569, 95% CI: 1.168, 2.108), age of 60 years and older (OR: 2.546, 95% CI: 1.865, 3.476), and BMIs of underweight (OR: 2.386, 95% CI: 1.259, 4.524) and obese (OR: 1.407, 95% CI: 1.113, 1.778) all had significantly increased odds for CKD. Our study concluded that urinary 2-hydroxynaphthalene, a form of PAH, is significantly associated with CKD.

Association of albumin to creatinine ratio with urinary arsenic and metal exposure: evidence from NHANES 2015-2016.

PURPOSE: Urinary metals can be used to identify metal exposure in humans from various sources in the environment. Decreased renal function and cardiovascular dysfunction may occur due to low levels of metal exposure in the general population. The purpose of this study is to assess the association between urinary arsenic and metals and a higher albumin to creatinine ratio (ACR) among adults in the general US population. METHODS: We conducted a cross sectional analyses using the 2015-2016 National Health and Nutrition Examination Survey (NHANES) dataset. Multiple linear logistic models were used to examine the association between 21 urinary arsenic and metal concentrations (arsenous acid, arsenic acid, arsenobetaine, arsenocholine, dimethylarsinic acid, monomethylarsonic acid, total arsenic, mercury, barium, cadmium, cobalt, cesium, molybdenum, manganese, lead, antinomy, tin, strontium, thallium, tungsten, uranium) and increased ACR (≥ 30 mg/g). RESULTS: The sample included 4122 adults, of whom approximately 9.4% of males and 10.7% females had increased ACRs. The exposure included urinary arsenic compounds (7) and urinary metal compounds (14) at or above the limit of detection. Urinary dimethylarsinic acid [OR 38.9, 95% CI 3.6-414.6], urinary monomethylarsonic acid [OR 18.6, 95% CI 1.1-308.2], urinary cadmium [OR 11.9, 95% CI 1.2-122.0], urinary cesium [OR 17.0, 95% CI 2.7-105.8], and urinary antimony [OR 10.7, 95% CI 2.2-51.3] were associated with an increased ACR. No other urinary metals were significantly associated with increased ACR. CONCLUSION: Increased ACR was positively associated with urinary dimethylarsinic acid, monomethylarsonic acid, cadmium, cesium, and antimony.

Association among urinary polycyclic aromatic hydrocarbons and depression: a cross-sectional study from NHANES 2015-2016.

Polycyclic aromatic hydrocarbons (PAHs) are a group of chemicals produced from incomplete combustion of carbon-containing products. PAH exposure is associated with pulmonary disease, cardiovascular disease, liver disease, and cancer. However, studies on the exposure to PAHs and depression are limited. The aim of this study is to investigate the relationship between seven types of urinary PAH exposure and depression in the adult population using the National Health and Nutrition Examination Survey (NHANES)2015-2016 dataset. The nine-item Patient Health Questionnaire (PHQ-9) was used to assess for depression; a PHQ-9 score ≥ 10 was considered depressed. Multivariate logistic regression analysis for complex survey procedures was used to assess the relationship between seven types of PAH exposure and depression. A total of 4,123 adults aged ≥20 years were included in the study sample. All forms of urinary PAHs studied, including 1-hydroxynaphthalene, 2-hydroxynaphthalene, 3-hydroxyfluorene, 2-hydroxyfluorene, 1-hydroxyphenanthrene, 1-hydroxypyrene, and 2 and 3-hydroxyphenanthrene, were positively associated with depression.

Urinary speciated arsenic and depression among US adults.

Arsenic is a naturally occurring chemical in the environment. The International Agency for Research on Cancer (IARC) declared arsenic a class 1 human carcinogen. The inorganic form of arsenic is considered toxic to the human population; arsenic is a neurotoxin and can cause memory dysfunction. Very few studies have investigated the association between exposure to arsenic and depression in humans. The purpose of this study was to assess the association between urinary speciated arsenic and depression among adults in the USA using the 2015-2016 National Health and Nutrition Examination Survey (NHANES) III dataset. Depression was measured using the nine-item Patient Health Questionnaire (PHQ-9). We computed a total depression score from the PHQ-9 and categorized individuals with a score ≥ 10 as depressed. The exposure included six different speciated arsenic concentrations dichotomized as at or above the limit of detection and below the limit of detection. We conducted a crude and multivariate logistic regression analysis using complex survey procedures to assess the association between speciated arsenic concentrations and depression. The sample included 1619 adults, of whom approximately half were females (51.69%) and married (53.29%). Seven percent of the sample had depression. Urinary arsenous acid was significantly associated with depression. In the adjusted model, arsenous acid was associated with depression with an odds ratio of 1.76 (95% CI 1.05-2.96, p = 0.035). No other forms of arsenic were significantly associated with depression. In this study, urinary arsenous acid was significantly associated with depression. Future research in humans is required to confirm or refute this finding.