{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T01:58:06Z","timestamp":1791251886010,"version":"4.1.0"},"reference-count":49,"publisher":"American Chemical Society (ACS)","issue":"11","license":[{"start":{"date-parts":[[2017,12,29]],"date-time":"2017-12-29T00:00:00Z","timestamp":1514505600000},"content-version":"vor","delay-in-days":1977,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2012,11,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Background: Although cadmium and lead are known risk factors for hearing loss in animal models, few epidemiologic studies have been conducted on their associations with hearing ability in the general population.<\/jats:p>\n                  <jats:p>Objectives: We investigated the associations between blood cadmium and lead exposure and hearing loss in the U.S. general population while controlling for noise and other major risk factors contributing to hearing loss.<\/jats:p>\n                  <jats:p>Methods: We analyzed data from 3,698 U.S. adults 20\u201369 years of age who had been randomly assigned to the National Health and Nutrition Examination Survey (NHANES) 1999\u20132004 Audiometry Examination Component. Pure-tone averages (PTA) of hearing thresholds at frequencies of 0.5, 1, 2, and 4 kHz were computed, and hearing loss was defined as a PTA &amp;gt; 25 dB in either ear.<\/jats:p>\n                  <jats:p>Results: The weighted geometric means of blood cadmium and lead were 0.40 [95% confidence interval (CI): 0.39. 0.42] \u00b5g\/L and 1.54 (95% CI: 1.49, 1.60) \u00b5g\/dL, respectively. After adjusting for sociodemographic and clinical risk factors and exposure to occupational and nonoccupational noise, the highest (vs. lowest) quintiles of cadmium and lead were associated with 13.8% (95% CI: 4.6%, 23.8%) and 18.6% (95% CI: 7.4%, 31.1%) increases in PTA, respectively (p-trends &amp;lt; 0.05).<\/jats:p>\n                  <jats:p>Conclusions: Our results suggest that low-level exposure to cadmium and lead found in the general U.S. population may be important risk factors for hearing loss. The findings support efforts to reduce environmental cadmium and lead exposures.<\/jats:p>","DOI":"10.1289\/ehp.1104863","type":"journal-article","created":{"date-parts":[[2012,7,31]],"date-time":"2012-07-31T15:14:11Z","timestamp":1343747651000},"page":"1544-1550","source":"Crossref","is-referenced-by-count":113,"title":["Environmental Cadmium and Lead Exposures and Hearing Loss in U.S. Adults: The National Health and Nutrition Examination Survey, 1999 to 2004"],"prefix":"10.1021","volume":"120","author":[{"given":"Yoon-Hyeong","family":"Choi","sequence":"first","affiliation":[{"name":"Department of Environmental Health Sciences,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Howard","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Environmental Health Sciences,"},{"name":"Department of Epidemiology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bhramar","family":"Mukherjee","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josef","family":"Miller","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, University of Michigan Medical School, Ann Arbor, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sung Kyun","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Environmental Health Sciences,"},{"name":"Department of Epidemiology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"316","published-online":{"date-parts":[[2012,7,31]]},"reference":[{"key":"2026080702062419200_micit1","unstructured":"Agency for Toxic Substances and Disease Registry\n          . 2010a. Case Studies in Environmental Medicine. Cadmium Toxicity. Atlanta, GA:Centers for Disease Control and Prevention.Available: http:\/\/www.atsdr.cdc.gov\/csem\/csem.asp?csem = 6&po = 0 [accessed 13 December 2011]."},{"key":"2026080702062419200_micit2","unstructured":"Agency for Toxic Substances and Disease Registry\n          . 2010b. Case Studies in Environmental Medicine. Lead Toxicity. Atlanta, GA: Centers for Disease Control and Prevention.Available: http:\/\/www.atsdr.cdc.gov\/csem\/csem.asp?csem = 6&po = 0 [accessed 13 December 2011]."},{"key":"2026080702062419200_micit3","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1097\/MAO.0b013e318192483c","article-title":"Risk factors for hearing loss in U.S. adults: data from the National Health and Nutrition Examination Survey, 1999 to 2002.","volume":"30","author":"Agrawal","year":"2009","journal-title":"Otol Neurotol"},{"key":"2026080702062419200_micit4","first-page":"699","article-title":"Cadmium and lead in blood in relation to low bone mineral density and tubular proteinuria.","volume":"110","author":"Alfv\u00e9n","year":"2002","journal-title":"Environ Health Perspect"},{"key":"2026080702062419200_micit5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.7326\/0003-4819-149-1-200807010-00231","article-title":"Diabetes and hearing impairment in the United States: audiometric evidence from the National Health and Nutrition Examination Survey, 1999 to 2004.","volume":"149","author":"Bainbridge","year":"2008","journal-title":"Ann Intern Med"},{"key":"2026080702062419200_micit6","unstructured":"CDC (Centers for Disease Control and Prevention)\n          . 2001a. Laboratory Procedure Manual: Blood Cadmium and Lead, NHANES 1999\u20132000. Method No. 1090A\/02-OD.Available: http:\/\/www.cdc.gov\/nchs\/data\/nhanes\/nhanes_99_00\/lab06_met_lead_and_cadmium.pdf [accessed 7 April 2011]."},{"key":"2026080702062419200_micit7","unstructured":"CDC (Centers for Disease Control and Prevention)\n          . 2001b. Laboratory Procedure Manual: Blood Cadmium and Lead, NHANES 2001\u20132002. Method No. 1090A\/02-OD.Available: http:\/\/www.cdc.gov\/nchs\/data\/nhanes\/nhanes_01_02\/l06_b_met_lead_and_cadmium.pdf [accessed 1 April 2011]."},{"key":"2026080702062419200_micit8","unstructured":"CDC (Centers for Disease Control and Prevention)\n          . 2004a. Laboratory Procedure Manual: Lead, Cadmium, and Mercury in Whole Blood, NHANES 2003\u20132004.Available: http:\/\/www.cdc.gov\/nchs\/data\/nhanes\/nhanes_03_04\/l06_c_met_pb_cd_hg.pdf [accessed 1 April 2011]."},{"key":"2026080702062419200_micit9","unstructured":"CDC (Centers for Disease Control and Prevention)\n          . 2004b. NHANES 1999\u20132000 Data Release\u2014May 2004: Frequencies of Blood Lead and Cadmium (Lab06).Available: http:\/\/www.cdc.gov\/nchs\/data\/nhanes\/nhanes_99_00\/lab06_frq.pdf [accessed 1 April 2011]."},{"key":"2026080702062419200_micit10","unstructured":"CDC (Centers for Disease Control and Prevention)\n          . 2005. National Health and Nutrition Examination Survey: 1999\u20132000 Data Documentation, Codebook, and Frequencies. Audiometry (AUX1).Available: http:\/\/www.cdc.gov\/nchs\/nhanes\/nhanes1999-2000\/AUX1.htm [accessed 24 October 2010]."},{"key":"2026080702062419200_micit11","unstructured":"CDC (Centers for Disease Control and Prevention)\n          . 2007a. National Health and Nutrition Examination Survey, 2007\u20132008. Overview.Available: http:\/\/www.cdc.gov\/nchs\/data\/nhanes\/nhanes_07_08\/overviewbrochure_0708.pdf [accessed 13 December 2011]."},{"key":"2026080702062419200_micit12","unstructured":"CDC (Centers for Disease Control and Prevention)\n          . 2007b. NHANES 1999\u20132000 Data Documentation. Last Revised: September 2007. Lab 6: Blood Lead and Cadmium.Available: http:\/\/www.nber.org\/nhanes\/1999_2000\/downloads\/lab06_doc.pdf [accessed 13 December 2011]."},{"key":"2026080702062419200_micit13","unstructured":"CDC (Centers for Disease Control and Prevention)\n          . 2007c. NHANES 2001\u20132002 Data Release Frequencies: Blood Lead and Cadmium (L06_B), May 2007.Available: http:\/\/www.cdc.gov\/nchs\/data\/nhanes\/nhanes_01_02\/l06_b_frq.pdf [accessed 1 April 2011]."},{"key":"2026080702062419200_micit14","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1186\/1476-069X-10-35","article-title":"High-frequency hearing loss, occupational noise exposure, and hypertension: a cross-sectional study in male workers.","volume":"10","author":"Chang","year":"2011","journal-title":"Environ Health"},{"key":"2026080702062419200_micit15","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/j.etap.2011.03.007","article-title":"Bone mineral density is related with previous renal dysfunction caused by cadmium exposure.","volume":"32","author":"Chen","year":"2011","journal-title":"Environ Toxicol Pharmacol"},{"key":"2026080702062419200_micit16","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1136\/oem.2011.064758","article-title":"Occupational noise exposure assessment using O*NET and its application to a study of hearing loss in the U.S. general population.","volume":"69","author":"Choi","year":"2012","journal-title":"Occup Environ Med"},{"key":"2026080702062419200_micit17","author":"Department of Health and Human Services","year":"2005"},{"key":"2026080702062419200_micit18","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/0167-8760(93)90080-9","article-title":"Effects of occupational exposure to mercury and lead on brainstem auditory evoked potentials.","volume":"14","author":"Discalzi","year":"1993","journal-title":"Int J Psychophysiol"},{"key":"2026080702062419200_micit19","doi-asserted-by":"crossref","first-page":"529","DOI":"10.2174\/1568026013394831","article-title":"Toxic metals and oxidative stress part I: mechanisms involved in metal-induced oxidative damage.","volume":"1","author":"Ercal","year":"2001","journal-title":"Curr Top Med Chem"},{"key":"2026080702062419200_micit20","doi-asserted-by":"crossref","first-page":"658","DOI":"10.1097\/00043764-199707000-00011","article-title":"Occupational lead exposure and hearing loss.","volume":"39","author":"Forst","year":"1997","journal-title":"J Occup Environ Med"},{"key":"2026080702062419200_micit21","doi-asserted-by":"crossref","first-page":"1782","DOI":"10.1289\/ehp.1001943","article-title":"Association between lead and cadmium and reproductive hormones in peripubertal U.S. girls.","volume":"118","author":"Gollenberg","year":"2010","journal-title":"Environ Health Perspect"},{"key":"2026080702062419200_micit22","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1093\/aje\/kwj090","article-title":"Confounding of the relation between homocysteine and peripheral arterial disease by lead, cadmium, and renal function.","volume":"163","author":"Guallar","year":"2006","journal-title":"Am J Epidemiol"},{"key":"2026080702062419200_micit23","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1177\/000348949610500813","article-title":"High-resolution computed tomographic evaluation of the cochlear capsule in otosclerosis: relationship between densitometry and sensorineural hearing loss.","volume":"105","author":"G\u00fcneri","year":"1996","journal-title":"Ann Otol Rhinol Laryngol"},{"key":"2026080702062419200_micit24","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1097\/00001648-199209000-00012","article-title":"Confidence interval estimation of interaction.","volume":"3","author":"Hosmer","year":"1992","journal-title":"Epidemiology"},{"key":"2026080702062419200_micit25","doi-asserted-by":"crossref","first-page":"1171","DOI":"10.1001\/jama.1996.03530390037031","article-title":"The relationship of bone and blood lead to hypertension. 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