A regional comparison of children’s blood cadmium, lead, and mercury in rural, urban and industrial areas of six European countries, and China, Ecuador, and Morocco
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Regional Authority of Public Health, Banská Bystrica, Slovakia
Charles University, Prague, Czech Republic (Third Faculty of Medicine)
Chinese Academy of Sciences, Beijing, China (Institute of High Energy Physics and National Center for Nanoscience and Technology)
Institute for Development of Production and Work Environment (IFA), Quito, Ecuador
Institut Jožef Stefan, Ljubljana, Slovenia (Department of Environmental Sciences)
Slovak Medical University Bratislava, Banská Bystrica, Slovakia (Faculty of Health)
National Institute of Public Health, Prague, Czech Republic
Abdelmalek Essaadi University, Tangier, Morocco (Laboratory of Chemistry and Biochemistry, Faculty of Medicine and Pharmacy)
Chinese Academy of Sciences, Beijing, China (Institute of High Energy Physics)
Lund University, Lund, Sweden (Division of Occupational and Environmental Medicine)
University Sidi Mohamed Ben Abdellah, Fez, Morocco (Laboratory of Natural Substances, Pharmacology, Environment, Modelling, Health and Quality of Life)
University Medical Centre Ljubljana, Ljubljana, Slovenia
Wroclaw Medical University, Wrocław, Poland (Department of Hygiene)
Medical University of Silesia, Zabrze, Poland (Department of Pharmacology, Faculty of Medical Sciences in Zabrze)
Institute for Ecology of Industrial Areas, Katowice, Poland
Umeå University, Umeå, Sweden (Department of Public Health and Clinical Medicine, Division of Sustainable Health)
Green Infrastructure Ltd, Zagreb, Croatia
Online publication date: 2023-08-28
Corresponding author
Ingvar A. Bergdahl   

Umeå University, Department of Public Health and Clinical Medicine, Division of Sustainable Health, 90187 Umeå, Sweden
Int J Occup Med Environ Health 2023;36(3):349–364
Objectives: The authors aimed to evaluate whether blood cadmium (B-Cd), lead (B-Pb) and mercury (B-Hg) in children differ regionally in 9 countries, and to identify factors correlating with exposure. Material and Methods: The authors performed a cross-sectional study of children aged 7–14 years, living in 2007–2008 in urban, rural, or potentially polluted (“hot spot”) areas (ca. 50 children from each area, in total 1363 children) in 6 European and 3 non-European countries. The authors analyzed Cd, Pb, and total Hg in blood and collected information on potential determinants of exposure through questionnaires. Regional differences in exposure levels were assessed within each country. Results: Children living near industrial “hot-spots” had B-Cd 1.6 (95% CI: 1.4–1.9) times higher in the Czech Republic and 2.1 (95% CI:1.6–2.8) times higher in Poland, as compared to urban children in the same countries (geometric means [GM]: 0.13 μg/l and 0.15 μg/l, respectively). Correspondingly, B-Pb in the “hot spot” areas was 1.8 (95% CI: 1.6–2.1) times higher than in urban areas in Slovakia and 2.3 (95% CI: 1.9–2.7) times higher in Poland (urban GM: 19.4 μg/l and 16.3 μg/l, respectively). In China and Morocco, rural children had significantly lower B-Pb than urban ones (urban GM: 64 μg/l and 71 μg/l, respectively), suggesting urban exposure from leaded petrol, water pipes and/or coal-burning. Hg “hot spot” areas in China had B-Hg 3.1 (95% CI: 2.7–3.5) times higher, and Ecuador 1.5 (95% CI: 1.2–1.9) times higher, as compared to urban areas (urban GM: 2.45 μg/l and 3.23 μg/l, respectively). Besides industrial exposure, traffic correlated with B-Cd; male sex, environmental tobacco smoke, and offal consumption with B-Pb; and fish consumption and amalgam fillings with B-Hg. However, these correlations could only marginally explain regional differences. Conclusions: These mainly European results indicate that some children experience about doubled exposures to toxic elements just because of where they live. These exposures are unsafe, identifiable, and preventable and therefore call for preventive actions. Int J Occup Med Environ Health. 2023;36(3):349–64