Yeungnam Univ J Med.  2019 May;36(2):141-147. 10.12701/yujm.2019.00178.

Association between cadmium exposure and hearing impairment: a population-based study in Korean adults

• Jung DJ

• KMID: 2449327
• DOI: http://doi.org/10.12701/yujm.2019.00178

Abstract

BACKGROUND
The present study aimed to evaluate the clinical association between cadmium exposure and hearing impairment among the Korean population.
METHODS
This retrospective cross-sectional study used the data obtained from the Korean National Health and Nutrition Examination Survey were used for our study. Finally, 3,228 participants were included in our study, which were then divided into quartiles based on their blood cadmium levels: first quartile (1Q), second quartile (2Q), third quartile (3Q), and fourth quartile (4Q) groups. The hearing thresholds were measured using an automatic audiometer at 0.5, 1, 2, 3, 4, and 6 kHz. Hearing loss (HL) was defined as >25 dB average hearing threshold (AHT).
RESULTS
All the groups had 807 participants each. The area under the receiver operating characteristic curves of cadmium level for HL were 0.634 (95% confidence interval [CI], 0.621-0.646). The participants in the 4Q group had higher Low/Mid-Freq, High-Freq, and AHT values than those in the other groups in the multivariate analysis after adjusting for confounding factors. The logistic regression showed that the OR for HL per 1 µg/L increase in cadmium was 1.25 (95% CI, 1.09-1.44; p=0.002) on the multivariate analysis. Moreover, the multivariate logistic regression analyses revealed that the participants in the 4Q group exhibited a 1.59-, 1.38-, and 1.41-fold higher odds for HL than those in the 1Q, 2Q, and 3Q groups, respectively.
CONCLUSION
High cadmium level quartile was associated with increased hearing thresholds and HL among the Korean adult population.

Keyword

Cadmium; Hearing loss; Heavy metals

MeSH Terms

Adult*
Cadmium*
Cross-Sectional Studies
Hearing Loss*
Hearing*
Humans
Logistic Models
Metals, Heavy
Multivariate Analysis
Nutrition Surveys
Retrospective Studies
ROC Curve
Cadmium
Metals, Heavy

Figure

• 

  Fig. 1. Receiver operating characteristic curve of cadmium level for the prediction of hearing loss.

• 

  Fig. 2. Hearing thresholds based on cadmium level quartiles. For the univariate analysis, the 1Q, 2Q, 3Q, and 4Q groups had mean Low/Mid-Freq values of 15.3±0.5, 16.5±0.5, 16.7±0.4, and 17.9±0.5, respectively; mean High-Freq values of 30.3±0.7, 31.2±0.7, 29.9±0.6, and 31.9±0.7, respectively; mean AHT values of 17.2±0.5, 18.3±0.5, 18.2±0.5, and 19.7±0.5, respectively. For the multivariate analysis, the 1Q, 2Q, 3Q, and 4Q groups had mean Low/Mid-Freq values of 15.1±0.5, 16.2±0.4, 16.6±0.4, and 18.0±0.4, respectively; mean High-Freq values of 28.0±0.7, 30.3±0.6, 30.7±0.6, and 33.7±0.6, respectively; mean AHT values of 16.6±0.5, 17.9±0.5, 18.3±0.5, and 20.1±0.5, respectively. The data are expressed as mean and standard error. The model 1 for hearing thresholds was adjusted for age, sex, presence of DM and hypertension, smoking habit, alcohol intake, and occupational and explosive noise exposure. The model 2 for hearing thresholds was adjusted for age, sex, presence of DM and hypertension, smoking habit, alcohol intake, occupational and explosive noise exposure, and lead level. a)p<0.05 vs. 1Q, b)p<0.05 vs. 2Q, c)p<0.05 vs. 3Q. 1Q, first quartile; 2Q, second quartile; 3Q, third quartile; 4Q, fourth quartile; Low/Mid-Freq, low or middle frequency; High-Freq, high frequency; AHT, average hearing threshold; DM, diabetes mellitus.

Reference

References

1. World Health Organization. Prevention of blindness and deafness [Internet]. Geneva: World Health Organization;2018. [cited 2018 April 15]. http://www.who.int/pbd/deafness/estimates/en/.

2. Roth JA, Salvi R. Ototoxicity of divalent metals. Neurotox Res. 2016; 30:268–82.

3. Ozcaglar HU, Agirdir B, Dinc O, Turhan M, Kilinçarslan S, Oner G. Effects of cadmium on the hearing system. Acta Otolaryngol. 2001; 121:393–7.

4. Kim SJ, Jeong HJ, Myung NY, Kim MC, Lee JH, So HS, et al. The protective mechanism of antioxidants in cadmium-induced ototoxicity in vitro and in vivo. Environ Health Perspect. 2008; 116:854–62.

5. Choi YH, Hu H, Mukherjee B, Miller J, Park SK. Environmental cadmium and lead exposures and hearing loss in U.S. adults: the National Health and Nutrition Examination Survey, 1999 to 2004. Environ Health Perspect. 2012; 120:1544–50.

6. Shiue I. Urinary environmental chemical concentrations and vitamin D are associated with vision, hearing, and balance disorders in the elderly. Environ Int. 2013; 53:41–6.

7. Korea Centers for Disease Control and Prevention. [Alcohol drinking] [Internet]. Osong: Korea Centers for Disease Control and Prevention;2017. [cited 2018 April 15]. http://health.mw.go.kr/HealthInfoArea/HealthInfo/View.do?idx=5800&subIdx=4&searchCate=&searchType=&searchKey=&pageNo=&category=1&category_code=301301306&dept=3&sortType=date&page=1&searchField=titleAndSummary&searchWord=.

8. Kang JW, Choi HS, Kim K, Choi JY. Dietary vitamin intake correlates with hearing thresholds in the older population: the Korean National Health and Nutrition Examination Survey. Am J Clin Nutr. 2014; 99:1407–13.

9. Choi WJ, Han SH. Blood Cadmium is associated with osteoporosis in obese males but not in non-obese males: the Korea National Health and Nutrition Examination Survey 2008-2011. Int J Environ Res Public Health. 2015; 12:12144–57.

10. Agency for Toxic Substances and Disease Registry. Public health statement for dadmium [Internet]. Atlanta: Agency for Toxic Substances and Disease Registry;2012. [cited 2018 April 15]. https://www.atsdr.cdc.gov/phs/phs.asp?id=46&tid=15.

11. Liu H, Ding D, Sun H, Jiang H, Wu X, Roth JA, et al. Cadmium-induced ototoxicity in rat cochlear organotypic cultures. Neurotox Res. 2014; 26:179–89.

12. Thatcher RW, McAlaster R, Lester ML. Evoked potentials related to hair cadmium and lead in children. Ann N Y Acad Sci. 1984; 425:384–90.

13. Shargorodsky J, Curhan SG, Henderson E, Eavey R, Curhan GC. Heavy metals exposure and hearing loss in US adolescents. Arch Otolaryngol Head Neck Surg. 2011; 137:1183–9.

14. Kang GH, Uhm JY, Choi YG, Kang EK, Kim SY, Choo WO, et al. Environmental exposure of heavy metal (lead and cadmium) and hearing loss: data from the Korea National Health and Nutrition Examination Survey (KNHANES 2010-2013). Ann Occup Environ Med. 2018; 30:22.