Exposure to Manganese in Drinking Water during Childhood and Association with Attention-Deficit Hyperactivity Disorder: A Nationwide Cohort Study
Manganese (Mn) in drinking water may increase the risk of several neurodevelopmental outcomes, including attention-deficit hyperactivity disorder (ADHD). Earlier epidemiological studies on associations between Mn exposure and ADHD-related outcomes had small sample sizes, lacked spatiotemporal exposu...
Gespeichert in:
| Veröffentlicht in: | Environmental health perspectives 2020-09, Vol.128 (9), p.97004 |
|---|---|
| Hauptverfasser: | , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | |
|---|---|
| container_issue | 9 |
| container_start_page | 97004 |
| container_title | Environmental health perspectives |
| container_volume | 128 |
| creator | Schullehner, Jörg Thygesen, Malene Kristiansen, Søren Munch Hansen, Birgitte Pedersen, Carsten Bøcker Dalsgaard, Søren |
| description | Manganese (Mn) in drinking water may increase the risk of several neurodevelopmental outcomes, including attention-deficit hyperactivity disorder (ADHD). Earlier epidemiological studies on associations between Mn exposure and ADHD-related outcomes had small sample sizes, lacked spatiotemporal exposure assessment, and relied on questionnaire data (not diagnoses)-shortcomings that we address here.
Our objective was to assess the association between exposure to Mn in drinking water during childhood and later development of ADHD.
In a nationwide population-based registry study in Denmark, we followed a cohort of 643,401 children born 1992-2007 for clinical diagnoses of ADHD. In subanalyses, we classified cases into ADHD-Inattentive and ADHD-Combined subtypes based on hierarchical categorization of International Classification of Diseases (ICD)-10 codes. We obtained Mn measurements from 82,574 drinking water samples to estimate longitudinal exposure during the first 5 y of life with high spatiotemporal resolution. We modeled exposure as both peak concentration and time-weighted average. We estimated sex-specific hazard ratios (HRs) in Cox proportional hazards models adjusted for age, birth year, socioeconomic status (SES), and urbanicity.
We found that exposure to increasing levels of Mn in drinking water was associated with an increased risk of ADHD-Inattentive subtype, but not ADHD-Combined subtype. After adjusting for age, birth year, and SES, females exposed to high levels of Mn (i.e.,
) at least once during their first 5 y of life had an HR for ADHD-Inattentive subtype of 1.51 [95% confidence interval (CI): 1.18, 1.93] and males of 1.20 (95% CI: 1.01, 1.42) when compared with same-sex individuals exposed to
. When modeling exposure as a time-weighted average, sex differences were no longer present.
Mn in drinking water was associated with ADHD, specifically the ADHD-Inattentive subtype. Our results support earlier studies suggesting a need for a formal health-based drinking water guideline value for Mn. Future Mn-studies should examine ADHD subtype-specific associations and utilize direct subtype measurements rather than relying on ICD-10 codes alone. https://doi.org/10.1289/EHP6391. |
| doi_str_mv | 10.1289/EHP6391 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7505135</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A637693318</galeid><sourcerecordid>A637693318</sourcerecordid><originalsourceid>FETCH-LOGICAL-c601t-baeec475dbd12a036eeae20fe3c3bc61458236764a9dc0f64a5e64fbb6a5ed6c3</originalsourceid><addsrcrecordid>eNqNkt1u0zAUxyMEYmMg3gBZQgJxkWHHsdtwgVS1hU4aDDE-Li3HPkk8UrvYzrY-Bm-My8pYpV4gXxwf-3f-Ol9Z9pTgY1KMq9fzxSdOK3IvOySMFXlVFeX97BDjiuR8xNlB9iiEC4wxGXP-MDugRcUYZeVh9mt-vXJh8ICiQx-kbaWFAMhYNPPG_jC2Rd9lBI_04DfOtDO97pzTSFqNJiE4ZWQ0zqIrEzs0iRHsxs1n0BhlIlqsV-CliubSxDWameC8Bv8GTdDHP3FXRgOaus75iM7joNePsweN7AM82dqj7Ou7-ZfpIj89e38ynZzmimMS81oCqHLEdK1JITHlABIK3ABVtFaclGxc0FR7KSutcJMsA142dc3TRXNFj7K3N7qroV6CVilvL3ux8mYp_Vo4acTujzWdaN2lGDHMCGVJ4PlWwLufA4QoLtzgbcpZFCWnvMBlVfyjWtmDMLZxSUwtTVBiwumIV5SScaLyPVQLNvWudzb1Mj3v8Md7-HQ0LI3aG_BqJyAxEa5jK4cQxMn55_9nz77tsi_usB3IPnbB9cNmtGEXfHkDKu9C8NDcdppgsdlhsd3hRD67O5hb7u_S0t_OrOut</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2463620492</pqid></control><display><type>article</type><title>Exposure to Manganese in Drinking Water during Childhood and Association with Attention-Deficit Hyperactivity Disorder: A Nationwide Cohort Study</title><source>Jstor Complete Legacy</source><source>MEDLINE</source><source>DOAJ Directory of Open Access Journals</source><source>EZB-FREE-00999 freely available EZB journals</source><source>PubMed Central</source><source>PubMed Central Open Access</source><creator>Schullehner, Jörg ; Thygesen, Malene ; Kristiansen, Søren Munch ; Hansen, Birgitte ; Pedersen, Carsten Bøcker ; Dalsgaard, Søren</creator><creatorcontrib>Schullehner, Jörg ; Thygesen, Malene ; Kristiansen, Søren Munch ; Hansen, Birgitte ; Pedersen, Carsten Bøcker ; Dalsgaard, Søren</creatorcontrib><description>Manganese (Mn) in drinking water may increase the risk of several neurodevelopmental outcomes, including attention-deficit hyperactivity disorder (ADHD). Earlier epidemiological studies on associations between Mn exposure and ADHD-related outcomes had small sample sizes, lacked spatiotemporal exposure assessment, and relied on questionnaire data (not diagnoses)-shortcomings that we address here.
Our objective was to assess the association between exposure to Mn in drinking water during childhood and later development of ADHD.
In a nationwide population-based registry study in Denmark, we followed a cohort of 643,401 children born 1992-2007 for clinical diagnoses of ADHD. In subanalyses, we classified cases into ADHD-Inattentive and ADHD-Combined subtypes based on hierarchical categorization of International Classification of Diseases (ICD)-10 codes. We obtained Mn measurements from 82,574 drinking water samples to estimate longitudinal exposure during the first 5 y of life with high spatiotemporal resolution. We modeled exposure as both peak concentration and time-weighted average. We estimated sex-specific hazard ratios (HRs) in Cox proportional hazards models adjusted for age, birth year, socioeconomic status (SES), and urbanicity.
We found that exposure to increasing levels of Mn in drinking water was associated with an increased risk of ADHD-Inattentive subtype, but not ADHD-Combined subtype. After adjusting for age, birth year, and SES, females exposed to high levels of Mn (i.e.,
) at least once during their first 5 y of life had an HR for ADHD-Inattentive subtype of 1.51 [95% confidence interval (CI): 1.18, 1.93] and males of 1.20 (95% CI: 1.01, 1.42) when compared with same-sex individuals exposed to
. When modeling exposure as a time-weighted average, sex differences were no longer present.
Mn in drinking water was associated with ADHD, specifically the ADHD-Inattentive subtype. Our results support earlier studies suggesting a need for a formal health-based drinking water guideline value for Mn. Future Mn-studies should examine ADHD subtype-specific associations and utilize direct subtype measurements rather than relying on ICD-10 codes alone. https://doi.org/10.1289/EHP6391.</description><identifier>ISSN: 0091-6765</identifier><identifier>EISSN: 1552-9924</identifier><identifier>DOI: 10.1289/EHP6391</identifier><identifier>PMID: 32955354</identifier><language>eng</language><publisher>United States: National Institute of Environmental Health Sciences</publisher><subject>Analysis ; Attention Deficit Disorder with Hyperactivity - epidemiology ; Attention deficit hyperactivity disorder ; Biomarkers ; Child ; Child development ; Childhood ; Children ; Cohort analysis ; Cohort Studies ; Confidence intervals ; Dietary Exposure - statistics & numerical data ; Drinking water ; Drinking Water - chemistry ; Epidemiology ; Exposure ; Female ; Gender aspects ; Groundwater ; Humans ; Hyperactivity ; Male ; Manganese ; Manganese - analysis ; Medical research ; Neurodevelopmental disorders ; Neurotoxicity ; Personal identification numbers ; Population ; Population studies ; Proportional Hazards Models ; Risk Factors ; Sex ; Sex differences ; Socioeconomics ; Statistical models ; Time series ; Water analysis ; Water Pollution, Chemical - statistics & numerical data ; Water quality ; Water sampling ; Water shortages ; Water supply</subject><ispartof>Environmental health perspectives, 2020-09, Vol.128 (9), p.97004</ispartof><rights>COPYRIGHT 2020 National Institute of Environmental Health Sciences</rights><rights>Reproduced from Environmental Health Perspectives. This article is published under https://ehp.niehs.nih.gov/about-ehp/copyright-permissions (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c601t-baeec475dbd12a036eeae20fe3c3bc61458236764a9dc0f64a5e64fbb6a5ed6c3</citedby><cites>FETCH-LOGICAL-c601t-baeec475dbd12a036eeae20fe3c3bc61458236764a9dc0f64a5e64fbb6a5ed6c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7505135/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7505135/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32955354$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Schullehner, Jörg</creatorcontrib><creatorcontrib>Thygesen, Malene</creatorcontrib><creatorcontrib>Kristiansen, Søren Munch</creatorcontrib><creatorcontrib>Hansen, Birgitte</creatorcontrib><creatorcontrib>Pedersen, Carsten Bøcker</creatorcontrib><creatorcontrib>Dalsgaard, Søren</creatorcontrib><title>Exposure to Manganese in Drinking Water during Childhood and Association with Attention-Deficit Hyperactivity Disorder: A Nationwide Cohort Study</title><title>Environmental health perspectives</title><addtitle>Environ Health Perspect</addtitle><description>Manganese (Mn) in drinking water may increase the risk of several neurodevelopmental outcomes, including attention-deficit hyperactivity disorder (ADHD). Earlier epidemiological studies on associations between Mn exposure and ADHD-related outcomes had small sample sizes, lacked spatiotemporal exposure assessment, and relied on questionnaire data (not diagnoses)-shortcomings that we address here.
Our objective was to assess the association between exposure to Mn in drinking water during childhood and later development of ADHD.
In a nationwide population-based registry study in Denmark, we followed a cohort of 643,401 children born 1992-2007 for clinical diagnoses of ADHD. In subanalyses, we classified cases into ADHD-Inattentive and ADHD-Combined subtypes based on hierarchical categorization of International Classification of Diseases (ICD)-10 codes. We obtained Mn measurements from 82,574 drinking water samples to estimate longitudinal exposure during the first 5 y of life with high spatiotemporal resolution. We modeled exposure as both peak concentration and time-weighted average. We estimated sex-specific hazard ratios (HRs) in Cox proportional hazards models adjusted for age, birth year, socioeconomic status (SES), and urbanicity.
We found that exposure to increasing levels of Mn in drinking water was associated with an increased risk of ADHD-Inattentive subtype, but not ADHD-Combined subtype. After adjusting for age, birth year, and SES, females exposed to high levels of Mn (i.e.,
) at least once during their first 5 y of life had an HR for ADHD-Inattentive subtype of 1.51 [95% confidence interval (CI): 1.18, 1.93] and males of 1.20 (95% CI: 1.01, 1.42) when compared with same-sex individuals exposed to
. When modeling exposure as a time-weighted average, sex differences were no longer present.
Mn in drinking water was associated with ADHD, specifically the ADHD-Inattentive subtype. Our results support earlier studies suggesting a need for a formal health-based drinking water guideline value for Mn. Future Mn-studies should examine ADHD subtype-specific associations and utilize direct subtype measurements rather than relying on ICD-10 codes alone. https://doi.org/10.1289/EHP6391.</description><subject>Analysis</subject><subject>Attention Deficit Disorder with Hyperactivity - epidemiology</subject><subject>Attention deficit hyperactivity disorder</subject><subject>Biomarkers</subject><subject>Child</subject><subject>Child development</subject><subject>Childhood</subject><subject>Children</subject><subject>Cohort analysis</subject><subject>Cohort Studies</subject><subject>Confidence intervals</subject><subject>Dietary Exposure - statistics & numerical data</subject><subject>Drinking water</subject><subject>Drinking Water - chemistry</subject><subject>Epidemiology</subject><subject>Exposure</subject><subject>Female</subject><subject>Gender aspects</subject><subject>Groundwater</subject><subject>Humans</subject><subject>Hyperactivity</subject><subject>Male</subject><subject>Manganese</subject><subject>Manganese - analysis</subject><subject>Medical research</subject><subject>Neurodevelopmental disorders</subject><subject>Neurotoxicity</subject><subject>Personal identification numbers</subject><subject>Population</subject><subject>Population studies</subject><subject>Proportional Hazards Models</subject><subject>Risk Factors</subject><subject>Sex</subject><subject>Sex differences</subject><subject>Socioeconomics</subject><subject>Statistical models</subject><subject>Time series</subject><subject>Water analysis</subject><subject>Water Pollution, Chemical - statistics & numerical data</subject><subject>Water quality</subject><subject>Water sampling</subject><subject>Water shortages</subject><subject>Water supply</subject><issn>0091-6765</issn><issn>1552-9924</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqNkt1u0zAUxyMEYmMg3gBZQgJxkWHHsdtwgVS1hU4aDDE-Li3HPkk8UrvYzrY-Bm-My8pYpV4gXxwf-3f-Ol9Z9pTgY1KMq9fzxSdOK3IvOySMFXlVFeX97BDjiuR8xNlB9iiEC4wxGXP-MDugRcUYZeVh9mt-vXJh8ICiQx-kbaWFAMhYNPPG_jC2Rd9lBI_04DfOtDO97pzTSFqNJiE4ZWQ0zqIrEzs0iRHsxs1n0BhlIlqsV-CliubSxDWameC8Bv8GTdDHP3FXRgOaus75iM7joNePsweN7AM82dqj7Ou7-ZfpIj89e38ynZzmimMS81oCqHLEdK1JITHlABIK3ABVtFaclGxc0FR7KSutcJMsA142dc3TRXNFj7K3N7qroV6CVilvL3ux8mYp_Vo4acTujzWdaN2lGDHMCGVJ4PlWwLufA4QoLtzgbcpZFCWnvMBlVfyjWtmDMLZxSUwtTVBiwumIV5SScaLyPVQLNvWudzb1Mj3v8Md7-HQ0LI3aG_BqJyAxEa5jK4cQxMn55_9nz77tsi_usB3IPnbB9cNmtGEXfHkDKu9C8NDcdppgsdlhsd3hRD67O5hb7u_S0t_OrOut</recordid><startdate>20200901</startdate><enddate>20200901</enddate><creator>Schullehner, Jörg</creator><creator>Thygesen, Malene</creator><creator>Kristiansen, Søren Munch</creator><creator>Hansen, Birgitte</creator><creator>Pedersen, Carsten Bøcker</creator><creator>Dalsgaard, Søren</creator><general>National Institute of Environmental Health Sciences</general><general>Environmental Health Perspectives</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>4T-</scope><scope>4U-</scope><scope>7RV</scope><scope>7ST</scope><scope>7T7</scope><scope>7U7</scope><scope>7WY</scope><scope>7WZ</scope><scope>7X7</scope><scope>7XB</scope><scope>87Z</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8FL</scope><scope>8G5</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>AN0</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BEZIV</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FRNLG</scope><scope>FYUFA</scope><scope>F~G</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>HCIFZ</scope><scope>K60</scope><scope>K6~</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>L.-</scope><scope>L6V</scope><scope>M0C</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>M7S</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PATMY</scope><scope>PIMPY</scope><scope>PQBIZ</scope><scope>PQBZA</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>Q9U</scope><scope>S0X</scope><scope>SOI</scope><scope>5PM</scope></search><sort><creationdate>20200901</creationdate><title>Exposure to Manganese in Drinking Water during Childhood and Association with Attention-Deficit Hyperactivity Disorder: A Nationwide Cohort Study</title><author>Schullehner, Jörg ; Thygesen, Malene ; Kristiansen, Søren Munch ; Hansen, Birgitte ; Pedersen, Carsten Bøcker ; Dalsgaard, Søren</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c601t-baeec475dbd12a036eeae20fe3c3bc61458236764a9dc0f64a5e64fbb6a5ed6c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Analysis</topic><topic>Attention Deficit Disorder with Hyperactivity - epidemiology</topic><topic>Attention deficit hyperactivity disorder</topic><topic>Biomarkers</topic><topic>Child</topic><topic>Child development</topic><topic>Childhood</topic><topic>Children</topic><topic>Cohort analysis</topic><topic>Cohort Studies</topic><topic>Confidence intervals</topic><topic>Dietary Exposure - statistics & numerical data</topic><topic>Drinking water</topic><topic>Drinking Water - chemistry</topic><topic>Epidemiology</topic><topic>Exposure</topic><topic>Female</topic><topic>Gender aspects</topic><topic>Groundwater</topic><topic>Humans</topic><topic>Hyperactivity</topic><topic>Male</topic><topic>Manganese</topic><topic>Manganese - analysis</topic><topic>Medical research</topic><topic>Neurodevelopmental disorders</topic><topic>Neurotoxicity</topic><topic>Personal identification numbers</topic><topic>Population</topic><topic>Population studies</topic><topic>Proportional Hazards Models</topic><topic>Risk Factors</topic><topic>Sex</topic><topic>Sex differences</topic><topic>Socioeconomics</topic><topic>Statistical models</topic><topic>Time series</topic><topic>Water analysis</topic><topic>Water Pollution, Chemical - statistics & numerical data</topic><topic>Water quality</topic><topic>Water sampling</topic><topic>Water shortages</topic><topic>Water supply</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Schullehner, Jörg</creatorcontrib><creatorcontrib>Thygesen, Malene</creatorcontrib><creatorcontrib>Kristiansen, Søren Munch</creatorcontrib><creatorcontrib>Hansen, Birgitte</creatorcontrib><creatorcontrib>Pedersen, Carsten Bøcker</creatorcontrib><creatorcontrib>Dalsgaard, Søren</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Opposing Viewpoints in Context (Gale)</collection><collection>Gale In Context: Science</collection><collection>ProQuest Central (Corporate)</collection><collection>Docstoc</collection><collection>University Readers</collection><collection>Proquest Nursing & Allied Health Source</collection><collection>Environment Abstracts</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Toxicology Abstracts</collection><collection>ABI/INFORM Collection</collection><collection>ABI/INFORM Global (PDF only)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>ABI/INFORM Global (Alumni Edition)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ABI/INFORM Collection (Alumni Edition)</collection><collection>Research Library (Alumni Edition)</collection><collection>Materials Science & Engineering Collection</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>Agricultural & Environmental Science Collection</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>Business Premium Collection</collection><collection>Technology Collection</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Business Premium Collection (Alumni)</collection><collection>Health Research Premium Collection</collection><collection>ABI/INFORM Global (Corporate)</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Business Collection (Alumni Edition)</collection><collection>ProQuest Business Collection</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>ABI/INFORM Professional Advanced</collection><collection>ProQuest Engineering Collection</collection><collection>ABI/INFORM Global</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Engineering Database</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Environmental Science Database</collection><collection>Publicly Available Content Database</collection><collection>One Business (ProQuest)</collection><collection>ProQuest One Business (Alumni)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>Engineering Collection</collection><collection>Environmental Science Collection</collection><collection>ProQuest Central Basic</collection><collection>SIRS Editorial</collection><collection>Environment Abstracts</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Environmental health perspectives</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Schullehner, Jörg</au><au>Thygesen, Malene</au><au>Kristiansen, Søren Munch</au><au>Hansen, Birgitte</au><au>Pedersen, Carsten Bøcker</au><au>Dalsgaard, Søren</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Exposure to Manganese in Drinking Water during Childhood and Association with Attention-Deficit Hyperactivity Disorder: A Nationwide Cohort Study</atitle><jtitle>Environmental health perspectives</jtitle><addtitle>Environ Health Perspect</addtitle><date>2020-09-01</date><risdate>2020</risdate><volume>128</volume><issue>9</issue><spage>97004</spage><pages>97004-</pages><issn>0091-6765</issn><eissn>1552-9924</eissn><abstract>Manganese (Mn) in drinking water may increase the risk of several neurodevelopmental outcomes, including attention-deficit hyperactivity disorder (ADHD). Earlier epidemiological studies on associations between Mn exposure and ADHD-related outcomes had small sample sizes, lacked spatiotemporal exposure assessment, and relied on questionnaire data (not diagnoses)-shortcomings that we address here.
Our objective was to assess the association between exposure to Mn in drinking water during childhood and later development of ADHD.
In a nationwide population-based registry study in Denmark, we followed a cohort of 643,401 children born 1992-2007 for clinical diagnoses of ADHD. In subanalyses, we classified cases into ADHD-Inattentive and ADHD-Combined subtypes based on hierarchical categorization of International Classification of Diseases (ICD)-10 codes. We obtained Mn measurements from 82,574 drinking water samples to estimate longitudinal exposure during the first 5 y of life with high spatiotemporal resolution. We modeled exposure as both peak concentration and time-weighted average. We estimated sex-specific hazard ratios (HRs) in Cox proportional hazards models adjusted for age, birth year, socioeconomic status (SES), and urbanicity.
We found that exposure to increasing levels of Mn in drinking water was associated with an increased risk of ADHD-Inattentive subtype, but not ADHD-Combined subtype. After adjusting for age, birth year, and SES, females exposed to high levels of Mn (i.e.,
) at least once during their first 5 y of life had an HR for ADHD-Inattentive subtype of 1.51 [95% confidence interval (CI): 1.18, 1.93] and males of 1.20 (95% CI: 1.01, 1.42) when compared with same-sex individuals exposed to
. When modeling exposure as a time-weighted average, sex differences were no longer present.
Mn in drinking water was associated with ADHD, specifically the ADHD-Inattentive subtype. Our results support earlier studies suggesting a need for a formal health-based drinking water guideline value for Mn. Future Mn-studies should examine ADHD subtype-specific associations and utilize direct subtype measurements rather than relying on ICD-10 codes alone. https://doi.org/10.1289/EHP6391.</abstract><cop>United States</cop><pub>National Institute of Environmental Health Sciences</pub><pmid>32955354</pmid><doi>10.1289/EHP6391</doi><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0091-6765 |
| ispartof | Environmental health perspectives, 2020-09, Vol.128 (9), p.97004 |
| issn | 0091-6765 1552-9924 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7505135 |
| source | Jstor Complete Legacy; MEDLINE; DOAJ Directory of Open Access Journals; EZB-FREE-00999 freely available EZB journals; PubMed Central; PubMed Central Open Access |
| subjects | Analysis Attention Deficit Disorder with Hyperactivity - epidemiology Attention deficit hyperactivity disorder Biomarkers Child Child development Childhood Children Cohort analysis Cohort Studies Confidence intervals Dietary Exposure - statistics & numerical data Drinking water Drinking Water - chemistry Epidemiology Exposure Female Gender aspects Groundwater Humans Hyperactivity Male Manganese Manganese - analysis Medical research Neurodevelopmental disorders Neurotoxicity Personal identification numbers Population Population studies Proportional Hazards Models Risk Factors Sex Sex differences Socioeconomics Statistical models Time series Water analysis Water Pollution, Chemical - statistics & numerical data Water quality Water sampling Water shortages Water supply |
| title | Exposure to Manganese in Drinking Water during Childhood and Association with Attention-Deficit Hyperactivity Disorder: A Nationwide Cohort Study |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-29T22%3A59%3A26IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Exposure%20to%20Manganese%20in%20Drinking%20Water%20during%20Childhood%20and%20Association%20with%20Attention-Deficit%20Hyperactivity%20Disorder:%20A%20Nationwide%20Cohort%20Study&rft.jtitle=Environmental%20health%20perspectives&rft.au=Schullehner,%20J%C3%B6rg&rft.date=2020-09-01&rft.volume=128&rft.issue=9&rft.spage=97004&rft.pages=97004-&rft.issn=0091-6765&rft.eissn=1552-9924&rft_id=info:doi/10.1289/EHP6391&rft_dat=%3Cgale_pubme%3EA637693318%3C/gale_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2463620492&rft_id=info:pmid/32955354&rft_galeid=A637693318&rfr_iscdi=true |