Mercury in the Swedish chloralkali industry--an evaluation of the exposure and preventive measures over 40 years

Mercury in serum predicts low risk of death and myocardial infarction in Gothenburg women

PURPOSE

Markers of mercury (Hg) exposure have shown both positive and negative associations with cardiovascular disease (CVD). We assessed the association between serum Hg (S-Hg) and risk of cardiovascular disease in a prospective population-based cohort, with attention to the roles of dental health and fish consumption.

METHODS

Total mortality, as well as morbidity and mortality from acute myocardial infarction (AMI) and stroke, was followed up for 32 years in 1,391 women (initially age 38-60), in relation to S-Hg at baseline, using Cox regression models. Potential confounders (age, socioeconomic status, serum lipids, alcohol consumption, dental health, smoking, hypertension, waist-hip ratio, and diabetes) and other covariates (e.g., fish consumption) were also considered.

RESULTS

Hazard ratios (HR) adjusted only for age showed strong inverse associations between baseline S-Hg and total mortality [highest quartile: hazard ratio (HR) 0.76; 95% confidence interval (CI) 0.59-0.97], incident AMI (HR 0.56; CI 0.34-0.93), and fatal AMI (HR 0.31; CI 0.15-0.66). Adjustment for potential confounding factors, especially dental health, had a strong impact on the risk estimates, and after adjustment, only the reduced risk of fatal AMI remained statistically significant.

CONCLUSIONS

There was a strong inverse association between Hg exposure and CVD. Likely, reasons are confounding with good dental health (also correlated with the number of amalgam fillings in these age groups) and/or fish consumption. The results suggest potential effects of dental health and/or fish consumption on CVD that deserve attention in preventive medicine.

Urinary mercury and biomarkers of early renal dysfunction in environmentally and occupationally exposed adults: a three-country study

We conducted a cross-sectional study in Sweden, Italy and Poland to assess environmental and occupational exposure to mercury from chloralkali (CA) plants and the potential association with biomarkers of early renal dysfunction. Questionnaire data and first-morning urine samples were collected from 757 eligible subjects. Urine samples were analysed for mercury corrected for creatinine (U-HgC), alpha-1-microglobulin (A1M), N-acetyl-beta-glucosaminidase (NAG) and albumin. Determinants of urinary mercury excretion were examined. Levels of kidney markers were compared in three U-HgC categories, and differences were tested taking age and other covariates into account. In the general population, the median U-HgC was higher in Italian (1.2 microg/gC) than in Polish (0.22 microg/gC) or Swedish (0.21 microg/gC) subjects, and no effect of living close to CA plants could be shown. Dental amalgam, chewing on amalgam, and fish consumption were positively associated with U-HgC. In subjects from the general population, no effects on the kidney markers could be detected, while in men, including workers occupationally exposed to mercury, U-HgC was positively associated with the kidney markers, especially with NAG, but to some extent also with A1M and albumin. Differences in urinary mercury and kidney markers in the general population between three studied countries could possibly be due to dietary factors, increased susceptibility to mercury at low selenium intake or co-exposure to other nephrotoxic metals.

Quantitative assessment of neuromotor function in workers with current low exposure to mercury vapor

Evaluation of neuromotor function has been used in several epidemiological studies of workers with long-term exposure to mercury vapor (Hg 0). Some recent studies indicate adverse effects at relatively low exposure levels. In the present study, we used sensitive quantitative methods, developed specifically to detect subtle effects of exposure to toxins on motor function. After exclusion of individuals with neurological diseases or other conditions that may affect performance, 43 chloralkali workers with current low exposure to Hg 0, and 22 age-matched referents remained for further analysis. The median urinary mercury concentration in exposed workers was 5.9 microg/g (range 1.3-25) creatinine (microg/gC), while that in referents was 0.7 microg/gC (range 0.2-4.1). The mean exposure time was 15 years, and the median cumulative mercury index was 161 years x microg/gC in exposed workers. A eurythmokinesimeter (EKM) was used to quantify eye-hand coordination, and a diadochokinesimeter, to measure rapid alternating rotation of the forearms. In general, the differences in performance between the exposed workers and the referents were small. Age was associated with a decrease in speed, more tremor, and longer contact duration between the stylus and the metal targets in performance of rapid pointing movements. Smokers had significantly more tremor, and more contacts per event in the EKM test, than nonsmokers. Taking age, shift work, and smoking habits into account, no significant associations with current or cumulative mercury exposure were found for the majority of the outcome variables from the quantitative tests. In general, this study indicates no significant adverse effects of Hg 0 on neuromotor function at the exposure levels studied.

Urinary mercury in people living near point sources of mercury emissions

As part of the European Mercury Emissions from Chlor Alkali Plants (EMECAP) project, we tested the hypothesis that contamination of ambient air with mercury around chlor alkali plants using mercury cells would increase the internal dose of mercury in people living close to the plants. Mercury in urine (U-Hg) was determined in 225 individuals living near a Swedish or an Italian chlor alkali plant, and in 256 age- and sex-matched individuals from two reference areas. Other factors possibly affecting mercury exposure were examined. Emissions and concentrations of total gaseous mercury (TGM) around the plants were measured and modeled. No increase in U-Hg could be demonstrated in the populations living close to the plants. This was the case also when the comparison was restricted to subjects with no dental amalgam and low fish consumption. The emissions of mercury to air doubled the background level, but contributed only about 2 ng/m(3) to long-term averages in the residential areas. The median U-Hg levels in subjects with dental amalgam were 1.2 microg/g creatinine (micro/gC) in Italy and 0.6 microg/gC in Sweden. In individuals without dental amalgam, the medians were 0.9 microg/gC and 0.2 microg/gC, respectively. The number of amalgam fillings, as well as chewing, fish consumption, and female sex were associated with higher U-Hg. The difference between the countries is probably due to higher fish consumption in Italy, demethylated methyl mercury (MeHg) being partly excreted in urine. Post hoc power calculations showed that if the background mercury exposure is low it may be possible to demonstrate an increase in U-Hg of as little as about 10 ng/m(3) as a contribution to ambient mercury from a point source.

Improving the in vivo X-ray fluorescence (XRF) measurement of renal mercury

In vivo polarised X-ray fluorescence (XRF) measurements of renal mercury have previously been reported (Börjesson J, Barregård L, Sällsten G, Schütz A, Jonson R, Alpsten M, Mattsson S, 1995. In vivo XRF analysis of mercury: the relation between concentrations in the kidney and the urine. Phys. Med. Biol. 40, 413-426). However, with the detection limit reported therein, this system is limited to measurements in cases of significant mercury exposure. An improvement in detection limit is desirable to produce a tool capable of occupational monitoring in cases of mild to moderate exposure. Therefore, design changes have been investigated to improve system performance. Through Monte Carlo simulation and experiment, optimal parameters were determined with respect to polarisation and filtration, as well as the ideal X-ray tube voltage. The optimal configuration will be discussed. A preliminary comparison in terms of minimum detectable limit (MDL) will be made with the preceding polarised XRF renal mercury system.

Comprehensive evaluation of long-term trends in occupational exposure: Part 1. Description of the database

OBJECTIVES

To conduct a comprehensive evaluation of long term changes in occupational exposure among a broad cross section of industries worldwide.

METHODS

A review of the scientific literature identified studies that reported historical changes in exposure. About 700 sets of data from 119 published and several unpublished sources were compiled. Data were published over a 30 year period in 25 journals that spanned a range of disciplines. For each data set, the average exposure level was compiled for each period and details on the contaminant, the industry and location, changes in the threshold limit value (TLV), as well as the type of sampling method were recorded. Spearman rank correlation coefficients were used to identify monotonic changes in exposure over time and simple linear regression analyses were used to characterise trends in exposure.

RESULTS

About 78% of the natural log transformed data showed linear trends towards lower exposure levels whereas 22% indicated increasing trends. (The Spearman rank correlation analyses produced a similar breakdown between exposures monotonically increasing or decreasing over time.) Although the rates of reduction for the data showing downward trends ranged from -1% to -62% per year, most exposures declined at rates between -4% and -14% per year (the interquartile range), with a median value of -8% per year. Exposures seemed to increase at rates that were slightly lower than those of exposures which have declined over time. Data sets that showed downward (versus upward) trends were influenced by several factors including type and carcinogenicity of the contaminant, type of monitoring, historical changes in the threshold limit values (TLVs), and period of sampling.

CONCLUSIONS

This review supports the notion that occupational exposures are generally lower today than they were years or decades ago. However, such trends seem to have been affected by factors related to the contaminant, as well as to the period and type of sampling.