Association of cobalt exposure with all-cause and cardiovascular mortality in U.S. adults

Abstract Background Cobalt exposure is recognized as a potential risk factor for cardiovascular disease (CVD). However, the impact of cobalt exposure on mortality, particularly concerning CVD-related deaths, in the U.S. remains uncertain. Methods Data from the National Health and Nutrition Examinati...

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Main Authors: Chunhui He, Min Gao, Ting He, Fuwei Xing
Format: Article
Language:English
Published: BMC 2025-05-01
Series:BMC Public Health
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Online Access:https://doi.org/10.1186/s12889-025-22753-w
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Summary:Abstract Background Cobalt exposure is recognized as a potential risk factor for cardiovascular disease (CVD). However, the impact of cobalt exposure on mortality, particularly concerning CVD-related deaths, in the U.S. remains uncertain. Methods Data from the National Health and Nutrition Examination Surveys (NHANES) spanning 1999–2018 were utilized to assess urinary cobalt levels in participants aged 20 years and older (n = 15,873). For the analysis of blood cobalt, data from NHANES covering the years 2015–2018 were considered, limited to participants aged 40 years and older (n = 6,692). The follow-up period extended until December 31, 2019. Results The median values of ln-transformed urinary cobalt (creatinine corrected) and blood cobalt were − 1.10 ln(µg/g) and − 1.90 ln(µg/L), respectively. For urinary cobalt, during a median follow-up period of 130.0 months (interquartile range: 70.25–189.0), 2,304 participants died, with 613 deaths attributed to CVD. After adjusting for potential covariates, an increase in urinary cobalt level was significantly associated with a higher risk of all-cause mortality and CVD mortality (per 1 ln-unit increment, HR: 1.19, 95% CI: 1.07, 1.32; HR: 1.30, 95% CI: 1.06, 1.60, respectively). For blood cobalt, the adjusted HRs were 1.57 (95% CI: 1.15, 2.14) for all-cause mortality and 2.02 (95% CI: 1.10, 3.72) for CVD mortality. Conclusions In the U.S., low-level environmental cobalt exposure is a significant risk factor for both all-cause mortality and CVD mortality. Synopsis Cobalt, a metallic element commonly encountered by the general population through food, water, or air inhalation, emerges as a novel risk factor for cardiovascular disease mortality.
ISSN:1471-2458