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This is a critical research gap given increased global industrialisation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A national cross-sectional study including spirometry was performed among 2112 adults across 11 provinces in China between 2020 and 2021. A total of 27 HTEs were quantified from urine samples. Generalised linear models and quantile-based g-computation were used to explore the individual and joint effects of urinary HTEs on lung function, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Overall, there were negative associations between forced expiratory volume in 1 s (FEV\n                      <jats:sub>1<\/jats:sub>\n                      ) and urinary arsenic (As) (z-score coefficient, \u22120.150; 95% CI, \u22120.262 to \u20130.038 per 1 ln-unit increase), barium (Ba) (\u22120.148, 95% CI: \u22120.258 to \u20130.039), cadmium (Cd) (\u22120.132, 95% CI: \u22120.236 to \u20130.028), thallium (Tl) (\u22120.137, 95% CI: \u22120.257 to \u20130.018), strontium (Sr) (\u22120.147, 95%\u2009CI: \u22120.273 to \u20130.022) and lead (Pb) (\u22120.121, 95% CI: \u22120.219 to \u20130.023). Similar results were observed for forced vital capacity (FVC) with urinary As, Ba and Pb and FEV\n                      <jats:sub>1<\/jats:sub>\n                      \/FVC with titanium (Ti), As, Sr, Cd, Tl and Pb. We found borderline associations between the ln-quartile of joint HTEs and decreased FEV\n                      <jats:sub>1<\/jats:sub>\n                      (\u221220\u2009mL, 95% CI: \u221248 to +8) and FVC (\u221214\u2009mL, 95% CI: \u221249 to+2). Ba and Ti were assigned the largest negative weights for FEV\n                      <jats:sub>1<\/jats:sub>\n                      and FVC within the model, respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our study investigating a wide range of HTEs in a highly polluted setting suggests that higher urinary HTE concentrations are associated with lower lung function, especially for emerging Ti and Ba, which need to be monitored or regulated to improve lung health.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/thorax-2022-219839","type":"journal-article","created":{"date-parts":[[2024,2,22]],"date-time":"2024-02-22T13:25:19Z","timestamp":1708608319000},"page":"615-623","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Comprehensive analysis of environmental 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