Association Between Urinary Heterocyclic Aromatic Amines and Mortality in Adults

Abstract

Heterocyclic aromatic amines (HAA) are mutagenic compounds; however, their long-term effects on humans remain poorly studied. This study investigated the association between HAA concentration and mortality in adults. Data from the National Health and Nutrition Examination Survey 2013-2014 were linked to mortality data from 2019 and analyzed using Cox regression analysis to determine the association of different HAA with all-cause, cardiovascular disease (CVD), and cancer mortality. Age, sex, education level, race, poverty income ratio, body mass index, smoking status, drinking status, and serum cotinine were included as covariates in three different Cox regression models. This study included 1,713 adults with a median age of 47 years (49.5% men). During a median follow-up at 71 months, 100 deaths occurred. Owing to detection limits, only four had discernible detection rates and were included in our analysis. Among them, only norharman concentration was significantly associated with all-cause and CVD mortality. The hazard ratio (HR) was 1.50 (95% confidence interval: 1.10–2.04) for all-cause mortality when analyzing norharman concentration as a natural log-transformed continuous variable and 3.33 (95% confidence interval: 2.24–4.95) for CVD mortality. Associations remained consistent when norharman concentrations were analyzed as binary variables (split by median). Urinary harman concentration seemed to show a negative association with cancer mortality. No definitive evidence was found of an association between other HAA and mortality. Urinary norharman concentration is associated with all-cause mortality and CVD mortality in adults.