Table 1_Association between urinary arsenic and hearing threshold shifts in adults in the United States, National Health and Nutrition Examination Survey, 2015–2016.docx

BackgroundHearing loss (HL) is a common sensory disorder in humans. Studies on the relationship between arsenic, which is a highly toxic and widely distributed heavy metal with a health risk to humans, and hearing status in humans are contradictory and mostly focused on people living in arsenic-contaminated areas. This study investigated the association between urinary arsenic levels and hearing threshold shifts in the general population in the United States.
MethodsOverall, 1,017 adults (aged 20–69 years) from the National Health and Nutrition Examination Survey (2015–2016) were included in this study. HL was defined as pure-tone average (PTA) ≥ 20 dB at frequencies 500, 1,000, 2000, and 4,000 Hz in the better-hearing ear. Total urinary arsenic (uAs) and dimethylarsinic acid (uDMA) levels were analyzed. Multivariate linear regression analyses and smooth curve fitting were performed to evaluate the correlations between uDMA, uAs, and low-, speech-, and high-frequency hearing levels.
ResultsThe mean age of the participants was 42.13 ± 13.66 years, including weighted 48.67% men and 12.88% participants with sensorineural HL. After adjusting for potential confounders in the multivariate linear regression model, higher uDMA levels were significantly associated with poor low-, and speech-frequency PTAs, with no differences among participants by age or sex. Smooth curve fitting indicated a nonlinear relationship between uAs and high-frequency PTA hearing threshold shifts. The uAs levels were positively associated with high-frequency PTA until the turning point of 1.54 (adjusted β 4.53, 95% CI 1.16, 7.90; p = 0.0085), beyond which this association was not observed (adjusted β −0.43, 95% CI −1.57, 0.71; p = 0.4600).
ConclusionWe found positive associations between urinary arsenic metabolites uDMA, uAs levels and poor hearing threshold shifts in US adults. This study provides new evidence for the association between arsenic exposure and auditory function.

背景：听力损失（Hearing Loss, HL）是人类常见的感觉功能障碍性疾病。现有关于砷——一种毒性极强、分布广泛且对人类健康具有危害的重金属——与人类听力状况之间关联的研究结论存在矛盾，且此类研究大多聚焦于居住在砷污染地区的人群。本研究旨在探究美国普通人群尿砷水平与听阈偏移之间的关联。
方法：本研究共纳入来自2015-2016年美国国家健康与营养检查调查（National Health and Nutrition Examination Survey, NHANES）的1017名成年人（年龄20~69岁）。听力损失的定义为：较好耳在500、1000、2000及4000Hz频率下的纯音听阈均值（Pure-tone Average, PTA）≥20dB。本研究检测了总尿砷（Total Urinary Arsenic, uAs）与二甲基胂酸（Dimethylarsinic Acid, uDMA）水平，并采用多因素线性回归分析与平滑曲线拟合，评估uDMA、uAs水平与低频、言语频率及高频听力水平之间的相关性。
结果：研究对象的平均年龄为42.13±13.66岁，经加权后男性占比为48.67%，感音神经性听力损失患者占比为12.88%。在多因素线性回归模型中校正潜在混杂因素后，较高的uDMA水平与较差的低频及言语频率纯音听阈均值显著相关，且该关联未因研究对象的年龄或性别而存在差异。平滑曲线拟合结果显示，uAs水平与高频纯音听阈均值的听阈偏移呈非线性关联：当uAs水平达到1.54的拐点之前，其水平与高频纯音听阈均值呈正相关（校正后β=4.53，95%置信区间[1.16,7.90]；p=0.0085）；当uAs水平超过该拐点后，未观察到此类关联（校正后β=-0.43，95%置信区间[-1.57,0.71]；p=0.4600）。
结论：本研究发现，美国成年人尿砷代谢物uDMA、uAs水平与较差的听阈偏移呈正相关。本研究为砷暴露与听觉功能之间的关联提供了新的证据。