Exposure to Manganese in Drinking Water during Childhood and Association with Attention-Deficit Hyperactivity Disorder: A Nationwide Cohort Study.
Exposure to Manganese in Drinking Water during Childhood and Association with Attention-Deficit Hyperactivity Disorder: A Nationwide Cohort Study.
复制标题
DOI：
10.1289/ehp6391
复制
发表时间：
2020-09
影响因子：
10.4
通讯作者：
Dalsgaard S
中科院分区：
文献类型：
--
作者：
Schullehner J;Thygesen M;Kristiansen SM;Hansen B;Pedersen CB;Dalsgaard S
饮用水中的锰可能会增加几种神经发育结果的风险，包括注意力缺陷多动障碍(ADHD)。早期关于锰暴露和ADHD相关结果之间关系的流行病学研究样本量小，缺乏时空暴露评估，并且依赖于问卷数据(而不是诊断)--我们在这里解决的缺点是。我们的目标是评估儿童时期接触饮用水中的锰与后来发展为ADHD之间的联系。在丹麦一项以人口为基础的全国性登记研究中，我们跟踪了1992-2007年出生的643,401名儿童的临床诊断ADHD。在亚分析中，根据国际疾病分类(ICD)-10编码的分层分类，将病例分为ADHD-疏忽亚型和ADHD-合并亚型。我们从82,574个饮用水样本中获得了高时空分辨率的锰测量，以估计生命最初5年的纵向暴露。我们将暴露建模为峰值浓度和时间加权平均值。我们根据年龄、出生年份、社会经济地位(SES)和都市性对Cox比例风险模型中的性别特定风险比(HR)进行了估计。我们发现，暴露于饮用水中不断增加的锰水平与ADHD注意力不集中亚型的风险增加有关，但与ADHD合并亚型无关。在调整了年龄、出生年份和SES后，与暴露于高水平锰的同性个体相比，在生命的头5年，暴露于高水平锰(即，至少一次)的女性ADHD注意力不集中亚型的比率为1.51[95%可信区间：1.18，1.93]，男性为1.20(95%可信区间：1.01，1.42)。当将暴露作为时间加权平均值建模时，性别差异不再存在。饮水中的锰与ADHD，特别是ADHD注意力不集中亚型有关。我们的结果支持了早期的研究，即需要一个正式的基于健康的饮用水MN指导值。未来的MN研究应该检查ADHD亚型特有的相关性，并利用直接的亚型测量，而不是仅仅依赖ICD-10编码。Https://doi.org/10.1289/EHP6391
Manganese (Mn) in drinking water may increase the risk of several neurodevelopmental outcomes, including attention-deficit hyperactivity disorder (ADHD). Earlier epidemiological studies on associations between Mn exposure and ADHD-related outcomes had small sample sizes, lacked spatiotemporal exposure assessment, and relied on questionnaire data (not diagnoses)—shortcomings that we address here. Our objective was to assess the association between exposure to Mn in drinking water during childhood and later development of ADHD. In a nationwide population-based registry study in Denmark, we followed a cohort of 643,401 children born 1992–2007 for clinical diagnoses of ADHD. In subanalyses, we classified cases into ADHD-Inattentive and ADHD-Combined subtypes based on hierarchical categorization of International Classification of Diseases (ICD)-10 codes. We obtained Mn measurements from 82,574 drinking water samples to estimate longitudinal exposure during the first 5 y of life with high spatiotemporal resolution. We modeled exposure as both peak concentration and time-weighted average. We estimated sex-specific hazard ratios (HRs) in Cox proportional hazards models adjusted for age, birth year, socioeconomic status (SES), and urbanicity. We found that exposure to increasing levels of Mn in drinking water was associated with an increased risk of ADHD-Inattentive subtype, but not ADHD-Combined subtype. After adjusting for age, birth year, and SES, females exposed to high levels of Mn (i.e., ) at least once during their first 5 y of life had an HR for ADHD-Inattentive subtype of 1.51 [95% confidence interval (CI): 1.18, 1.93] and males of 1.20 (95% CI: 1.01, 1.42) when compared with same-sex individuals exposed to . When modeling exposure as a time-weighted average, sex differences were no longer present. Mn in drinking water was associated with ADHD, specifically the ADHD-Inattentive subtype. Our results support earlier studies suggesting a need for a formal health-based drinking water guideline value for Mn. Future Mn-studies should examine ADHD subtype-specific associations and utilize direct subtype measurements rather than relying on ICD-10 codes alone. https://doi.org/10.1289/EHP6391