Intra-household agreement of urinary elemental concentrations in Tanzania and Kenya: potential surrogates in case–control studies

• Published in: Journal of exposure science & environmental epidemiology Vol. 29; no. 3; pp. 335 - 343
• Main Authors: Middleton, Daniel R. S., McCormack, Valerie A., Munishi, Michael O., Menya, Diana, Marriott, Andrew L., Hamilton, Elliott M., Mwasamwaja, Amos O., Mmbaga, Blandina T., Samoei, David, Osano, Odipo, Schüz, Joachim, Watts, Michael J.
• Format: Journal Article
• Language: English
• Published: New York Nature Publishing Group US 01-04-2019; Nature Publishing Group
• Subjects: Adolescent; Adult; Adults; Aged; Analysis; Antimony; Biological markers; Biomarkers; Biomarkers - urine; Bismuth; Cadmium; Canadians; Case-Control Studies; Cesium; Communicable diseases; Copper; Correlation; Disease control; Epidemiology; Family Characteristics; Female; Households; Humans; Kenya; Lead; Lithium; Male; Manganese; Medical research; Medicine; Medicine & Public Health; Middle Aged; Molybdenum; Nickel; Prospective Studies; Proxy; Selenium; Tanzania; Tin; Trace Elements - urine; Urine; Young Adult; Kenya; Tanzania; Urine; Micronutrients; Trace elements; Cancer epidemiology
• ISSN: 1559-0631; 1559-064X; 1559-064X
• DOI: 10.1038/s41370-018-0071-8

Element deficiencies and excesses play important roles in non-communicable disease aetiology. When investigating their roles in epidemiologic studies without prospective designs, reverse-causality limits the utility of transient biomarkers in cases. This study aimed to investigate whether surrogate participants may provide viable proxies by assessing concentration correlations within households. We obtained spot urine samples from 245 Tanzanian and Kenyan adults (including 101 household pairs) to investigate intra-household correlations of urinary elements (As, Ba, Ca, Cd, Co, Cs, Cu, Fe, Li, Mn, Mo, Ni, Pb, Rb, S, Se, Sr, Tl, V and Zn) and concentrations (also available for: Bi, Ce, Sb, Sn and U) relative to external population-levels and health-based values. Moderate-strong correlations were observed for As (
r
 = 0.65), Cs (
r
 = 0.67), Li (
r
 = 0.56), Mo (
r
 = 0.57), Se (
r
 = 0.68) and Tl (
r
 = 0.67). Remaining correlations were <0.41. Median Se concentrations in Tanzania (29 µg/L) and Kenya (24 µg/L) were low relative to 5738 Canadians (59 µg/L). Exceedances (of reference 95th percentiles) were observed for: Co, Mn, Mo, Ni and U. Compared to health-based values, exceedances were present for As, Co, Mo and Se but deficiencies were also present for Mo and Se. For well correlated elements, household members in East African settings provide feasible surrogate cases to investigate element deficiencies/excesses in relation to non-communicable diseases.