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J. Hazard. Mater., Available online 13 January 2026, 141141 | https://doi.org/10.1016/j.jhazmat.2026.141141 Heavy metal exposure and all health outcomes: an umbrella review of meta-analyses

Hogeon Lee ^a,1, Yeona Jo ^b,c,1, Minwoo Jung ^b,d,1, Jung Hyun Lee ^a, Tae Hee Kim ^a, Jungmin Lee ^a, Da Jung Kim ^a, Masoud Rahmati ^e,f, Lee Smith ^g,h, Damiano Pizzol^i,j, Yejun Son ^b,c, Jaeyu Park ^b,c, Sung-Hoon Ahn ^k, Dong Keon Yon ^b,c,d,l,2, Dal Woong Choi ^a,m,n,2, Jiseung Kang ^m,n,2

^aTransdisciplinary Major in Learning Health Systems, Department of Health and Safety Convergence Science, Graduate School, Korea University, Seoul, Republic of Korea
^bCenter for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
^cDepartment of Precision Medicine, Kyung Hee University College of Medicine, Seoul, South Korea
^dDepartment of Medicine, Kyung Hee University College of Medicine, Seoul, South Korea
^eCEReSS-Health Service Research and Quality of Life Center, Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, Marseille, France
^fCRSMP, Center for Mental Health and Psychiatry Research - PACA, Marseille, France
^gCentre for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge, UK
^hDepartment of Public Health, Faculty of Medicine, Biruni University, Istanbul, Turkey
ⁱHealth Unit, Eni, Maputo, Mozambique
^jHealth Unit, Eni, San Donato Milanese, Italy
^kCollege of Pharmacy, Kangwon National University, South Korea
^lDepartment of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
^mSchool of Health and Environmental Science, College of Health Science, Korea University, Seoul, South Korea
ⁿDepartment of Health and Safety Convergence Science, Graduate School, Korea University, Seoul, Republic of Korea

¹These authors contributed equally to this work as first authors.
²These authors jointly supervised this work.
Correspondence to: Dal Woong Choi, Jiseung Kang

Abstract

We aimed to systematically evaluate the strength and credibility of evidence linking exposure to five major heavy metals, including arsenic, cadmium, lead, mercury, and chromium, with health outcomes (PROSPERO, CRD420251169899). Literature searches of PubMed/Embase, CINAHL, and Google Scholar up to April 20, 2025, identified meta-analyses of observational studies assessing these associations. Effect sizes were recalculated using random-effects models and expressed as equivalent odds ratios (eOR) with 95% confidence intervals (CIs). The methodological quality of the included reviews was assessed using the AMSTAR2, and the credibility of associations was graded according to predefined criteria: Class I (convincing), Class II (highly suggestive), Class III (suggestive), Class IV (weak), and non-significant (NS). A total of 35 meta-analyses encompassing 103 health outcomes were included. Arsenic exposure was associated with melanoma (eOR 1.50 [95% CI, 1.0-2.24], CE=IV), digestive cancers (1.23 [1.07-1.41], CE=III), gestational diabetes mellitus (1.47 [1.11-1.95], CE=III), hypertension (1.15 [1.06-1.24], CE=III), and preterm birth (1.12 [1.04-1.21], CE=III). Lead exposure showed significant associations with autistic disorder in children (12.70 [3.93-41.10], CE=IV), hearing loss (7.55 [6.69-8.53], CE=III), age-related eye disease (9.80 [1.72-55.85], CE=IV), and amyotrophic lateral sclerosis (1.46 [1.16-1.83], CE=III). Mercury exposure was linked to increased risk in membranous nephropathy (5.75 [1.54-21.44], CE=IV) and thyroid cancer (1.90 [1.55-2.33], CE=IV). Cadmium exposure was associated with renal cancer (1.47 [1.26-1.71], CE=II), cardiovascular disease (1.33 [1.05-1.69], CE=IV), stroke (1.36 [1.10-1.68], CE=III), diabetes mellitus (1.27 [1.07-1.52], CE=III), fracture risk (1.30 [1.13-1.49], CE=III), and age-related eye disease (113.26 [16.86-760.68], CE=III). Chromium exposure was associated with stomach cancer (1.28 [1.16-1.41], CE=I), supporting convincing evidence. Overall, exposures to these metals were consistently associated with diverse diseases across organ systems and life stages, suggesting proactive implications against heavy metal exposures.

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