Chinese Exposure and Response Mapping Program (CERMP): Hazardous Trace Elements

Background: Identifying hazardous trace elements (HTEs) is a critical function of public health. We aimed to identify HTEs using a panel of sensitive health indicators in a random sample of Chinese. Methods: Between August 13, 2020 and October 1, 2021, we recruited 2883 participants aged 18-75 years from 12 Chinese provinces using simple random sampling method and tested their plasma for 27 hazardous trace elements (HTEs). We also examined 36 biomarkers of impairments of the hepatic, renal, cardiovascular and immune systems, as well as lung function. We used two-level generalized linear regression models to assess associations between HTEs exposure and health outcomes adjusting for confounders. We used standardized Z-score to examine association of the sum of standard coefficients of a select HTEs and comprehensive set of health indicators. Findings: We found the most frequent and strongest human health indicator associations with plasma Ti, Sr, Ba, Ce and Y, especially for cardiovascular function. However, exposure to these five HTEs is not currently monitored in China and other countries. Interpretation: A more comprehensive and definitive study of Ti, Sr, Ba, Y and Ce exposure is merited to further investigate potential adverse human health effects and to inform possible interventions.Funding: We would like to thank the National Key R&D Program of China (Grant No. 2019YFC1803402), the National Natural Science Foundation of China (Grant No. 82173471, 41931298).Declaration of Interest: We declare no competing interests.Ethical Approval: The CERMP study protocol was approved by the Research Ethics Committee of Sun Yat-sen University. We obtained written informed consent from all participants before data and biospecimen collection.