Exposure to Cadmium and Cerebrovascular Mortality in the United States

Cerebrovascular diseases are a leading cause of death in the U.S., and emerging evidence suggests that environmental toxicants such as cadmium may contribute to cerebrovascular risk. This study investigates the association between cadmium exposure and cerebrovascular mortality in a nationally representative sample of U.S. adults.

We analyzed data from adults aged ≥40 years in the National Health and Nutrition Examination Survey (NHANES) 1999-2016 cycles, with mortality follow-up through 2019. Blood cadmium was measured in 23,455 participants, and urinary cadmium was measured in 8,929 participants. Cerebrovascular deaths were identified through linkage with the National Death Index. Survey-weighted Cox proportional hazards models evaluated associations between cadmium concentrations and cerebrovascular mortality.

Over a mean follow-up of 10.2 years, 247 cerebrovascular deaths were observed. Each interquartile range increase in blood cadmium (0.40 μg/L) was associated with a 23% higher risk of cerebrovascular mortality (HR=1.23, 95% CI: 1.04-1.46). Urinary cadmium was also associated with higher cerebrovascular mortality, although marginally significant (HR=1.36 per doubling, 95% CI: 0.99-1.87). Associations appeared stronger among former and current smokers, though interaction terms were not statistically significant.

Cadmium exposure is associated with increased cerebrovascular mortality in the U.S. population. These findings support cadmium as a modifiable environmental risk factor and underscore the need for public health interventions to reduce exposure through tobacco control, dietary regulations, and environmental policy.