Gender and Sexual Orientation Disparities in Smoking, Cadmium Exposure, and Estimated GFR: National Health and Nutrition Examination Survey 2005-2014

BACKGROUND AND AIM: Chronic kidney disease (CKD) is a progressive disease characterized by structural, molecular, and functional nephron changes that eventually result in permanent loss of function. CKD can lead to heart disease, stroke, and end stage kidney disease. Studies have linked cadmium exposure to decreased glomerular filtration rate (GFR) and renal pathogenesis. The main non-occupational pathway for cadmium exposure is from tobacco smoke. Lesbian, gay, and bisexual (LGB) individuals have one of the highest subpopulation smoking rates, yet studies have not examined if they have higher cadmium exposure or renal disease burden. The aim of this study was to evaluate gender and sexual orientation disparities in cadmium exposure and estimated glomerular filtration rate (eGFR) in the National Health and Nutrition Examination Survey (NHANES) from 2005-2014 in 16,576 individuals. METHODS: The analysis used a combination of geometric means and survey linear regression to evaluate cadmium burden and eGFR. RESULTS:The percentage of smokers among LGB participants was higher (44.2%) than in straight participants (28.7%). Comparing geometric mean blood cadmium of males showed that straight men have the lowest cadmium levels (0.297 ng/L) and bisexual men have the highest cadmium levels (0.347 ng/L). Among females, straight females have the lowest cadmium levels (0.354 ng/L) and gay females have the highest cadmium levels (0.446 ng/L). There were statistically significant differences between odds ratios of low eGFR by gender and sexual orientation. Compared to straight males, the odds ratio for low eGFR among gay males was 0.824 (95% CI 0.820, 0.827; p0.0003) bisexual males was 0.634 (95% CI 0.549, 0.555; p0.0001), straight females was 0.844 (95% CI 0.843, 0.845; p0.0001), gay females was 0.783 (95% CI 0.778, 0.788; p0.0001), and bisexual females was 1.092 (95% CI 1.089, 1.096; p0.0001). CONCLUSIONS:This analysis highlights the need for additional research specifically addressing disparities related to gender identity and sexual orientation. KEYWORDS: NHANES, cadmium, kidney disease, sexual orientation, gender, disparities