Association Between Bisphenol A Exposure and Risk of All-Cause and Cause-Specific Mortality in US Adults
Association Between Bisphenol A Exposure and Risk of All-Cause and Cause-Specific Mortality in US Adults
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DOI：
10.1001/jamanetworkopen.2020.11620
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发表时间：
2020-08-17
影响因子：
13.8
通讯作者：
Lehmler, Hans-Joachim
中科院分区：
文献类型：
--
作者：
Bao, Wei;Liu, Buyun;Lehmler, Hans-Joachim
双酚A （BPA）是一个主要的公共卫生问题，因为它的大量工业生产，人类无处不在的接触，以及对人体多个器官和系统的潜在毒性作用。然而，关于BPA暴露与长期健康结果之间关系的前瞻性研究很少。目的研究BPA暴露与美国成人全因死亡率和病因特异性死亡率的关系。设计、环境和参与者：这项具有全国代表性的队列研究包括3883名20岁及以上的成年人，他们参加了2003-2008年美国国家健康与营养调查，并提供了尿液样本用于BPA水平测量。参与者与调查日期至2015年12月31日的死亡率数据有关。数据分析于2019年7月进行。采用在线固相萃取-高效液相色谱-同位素稀释串联质谱法定量测定尿液BPA水平。主要结局和测量方法：全因死亡率、心血管疾病和癌症。结果该队列研究纳入3883名20岁及以上的成年人（加权平均[SE]年龄43.6[0.3]岁；2032名女性[加权，51.4%]）。在36514人年的随访期间（中位数为9.6年，最长为13.1年），发生了344例死亡，其中71例死于心血管疾病，75例死于癌症。尿液中BPA含量较高的参与者死亡的风险更高。在调整了年龄、性别、种族/民族、社会经济地位、饮食和生活方式因素、体重指数和尿肌酐水平后，尿中BPA水平最高与最低比值的全因死亡率风险比为1.49 (95% CI, 1.01-2.19)，心血管疾病死亡率风险比为1.46 (95% CI, 0.67-3.15)，癌症死亡率风险比为0.98 （95% CI, 0.40-2.39）。结论和相关性在这个具有全国代表性的美国成年人队列中，较高的BPA暴露与全因死亡率风险增加显著相关。需要进一步的研究来在其他人群中复制这些发现并确定潜在的机制。
IMPORTANCE Bisphenol A (BPA) is a major public health concern because of its high-volume industrial production, ubiquitous exposure to humans, and potential toxic effects on multiple organs and systems in humans. However, prospective studies regarding the association of BPA exposure with long-term health outcomes are sparse.OBJECTIVE To examine the association of BPA exposure with all-cause mortality and cause-specific mortality among adults in the United States.DESIGN, SETTING, AND PARTICIPANTS This nationally representative cohort study included 3883 adults aged 20 years or older who participated in the US National Health and Nutrition Examination Survey 2003-2008 and provided urine samples for BPA level measurements. Participants were linked to mortality data from survey date through December 31, 2015. Data analyses were conducted in July 2019.EXPOSURES Urinary BPA levels were quantified using online solid-phase extraction coupled to high-performance liquid chromatography-isotope dilution tandem mass spectrometry.MAIN OUTCOMES AND MEASURES Mortality from all causes, cardiovascular disease, and cancer.RESULTS This cohort study included 3883 adults aged 20 years or older (weighted mean [SE] age, 43.6 [0.3] years; 2032 women [weighted, 51.4%]). During 36 514 person-years of follow-up (median, 9.6 years; maximum, 13.1 years), 344 deaths occurred, including 71 deaths from cardiovascular disease and 75 deaths from cancer. Participants with higher urinary BPA levels were at higher risk for death. After adjustment for age, sex, race/ethnicity, socioeconomic status, dietary and lifestyle factors, body mass index, and urinary creatinine levels, the hazard ratio comparing the highest vs lowest tertile of urinary BPA levels was 1.49 (95% CI, 1.01-2.19) for all-cause mortality, 1.46 (95% CI, 0.67-3.15) for cardiovascular disease mortality, and 0.98 (95% CI, 0.40-2.39) for cancer mortality.CONCLUSIONS AND RELEVANCE In this nationally representative cohort of US adults, higher BPA exposure was significantly associated with an increased risk of all-cause mortality. Further studies are needed to replicate these findings in other populations and determine the underlying mechanisms.