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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author Chunhui He
Min Gao
Ting He
Fuwei Xing
author_facet Chunhui He
Min Gao
Ting He
Fuwei Xing
author_sort Chunhui He
collection DOAJ
description 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.
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spelling doaj-art-48e707eb80cf4edeaddd2c02f60fef822025-08-20T02:25:16ZengBMCBMC Public Health1471-24582025-05-0125111110.1186/s12889-025-22753-wAssociation of cobalt exposure with all-cause and cardiovascular mortality in U.S. adultsChunhui He0Min Gao1Ting He2Fuwei Xing3Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing Key Laboratory of Preclinical Research and Evaluation for Cardiovascular Implant Materials, Animal Experimental Centre, National Centre for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeDepartment of Cardiology, Biomedical Innovation Center, The Sixth Affiliated Hospital of Sun Yat-Sen UniversityAbstract 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.https://doi.org/10.1186/s12889-025-22753-wCobaltCardiovascular diseaseMortalityNHANES
spellingShingle Chunhui He
Min Gao
Ting He
Fuwei Xing
Association of cobalt exposure with all-cause and cardiovascular mortality in U.S. adults
BMC Public Health
Cobalt
Cardiovascular disease
Mortality
NHANES
title Association of cobalt exposure with all-cause and cardiovascular mortality in U.S. adults
title_full Association of cobalt exposure with all-cause and cardiovascular mortality in U.S. adults
title_fullStr Association of cobalt exposure with all-cause and cardiovascular mortality in U.S. adults
title_full_unstemmed Association of cobalt exposure with all-cause and cardiovascular mortality in U.S. adults
title_short Association of cobalt exposure with all-cause and cardiovascular mortality in U.S. adults
title_sort association of cobalt exposure with all cause and cardiovascular mortality in u s adults
topic Cobalt
Cardiovascular disease
Mortality
NHANES
url https://doi.org/10.1186/s12889-025-22753-w
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AT tinghe associationofcobaltexposurewithallcauseandcardiovascularmortalityinusadults
AT fuweixing associationofcobaltexposurewithallcauseandcardiovascularmortalityinusadults