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


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.

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The authors thank Dr. Graham Byrnes and Liacine Bouaoun for statistical discussions and advice.


Funding was received from an NIH grant (R21CA191965) with support from BGS Global and the Centre for Environmental Geochemistry. The work reported was undertaken during the tenure of a Postdoctoral Fellowship from the International agency for Research on cancer, partially supported by the European Commission FP7 Marie Curie Actions—People—Co-funding of regional, national and international programmes (COFUND) and a UICC IARC Development Fellowship.

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Correspondence to Daniel R. S. Middleton.

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The authors declare that they have no conflict of interest.

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Ethical approval was granted at IARC (IEC 14–15), in Tanzania (NIMR/HQ/R.8a) and Moi University in Kenya (IREC 000921). Informed consent was obtained from all participants.

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Middleton, D.R.S., McCormack, V.A., Munishi, M.O. et al. Intra-household agreement of urinary elemental concentrations in Tanzania and Kenya: potential surrogates in case–control studies. J Expo Sci Environ Epidemiol 29, 335–343 (2019).

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  • Micronutrients
  • Trace elements
  • Urine
  • Cancer epidemiology

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