ORIGINAL RESEARCH article
Front. Public Health
Sec. Occupational Health and Safety
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1639229
This article is part of the Research TopicImpact of inhaled particulates and toxicants on brain health: inflammation mechanisms and behavioral consequencesView all 3 articles
Hemoglobin-to-red blood cell distribution width ratio in the relationship between occupational aluminum exposure and cognitive function impairment: a mediation analysis
Provisionally accepted
Ruo-Nan Wang1,2Zhuo-Hui Wang1,2Wen-Cheng Hu1,2Fan-Peng Kong1,2Zi-Yan Pei1,2Jing Song2
Xiaoting Lu2
Baolong Pan1*- 1General hospital of TISCO, Taiyuan, China
- 2Shanxi Medical University, Taiyuan, China
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[Objective] To investigate the partial mediating role of the inflammatory marker hemoglobin-to-red cell distribution width ratio (HRR) in the association between occupational aluminum exposure and cognitive function impairment, and its significance. [Methods] In this study, 401 workers from a Shanxi aluminum plant were selected by Cluster Sampling. Fasting elbow venous blood was collected for measuring routine blood counts, plasma aluminum concentration (P-Al) was measured using inductively coupled plasma mass spectrometry (ICP-MS), Montreal Cognitive Assessment (MoCA) was used to assess the cognitive function. Multiple linear regression was used to analyze the relationship between P-Al and cognitive function and HRR, and a restricted cubic spline model was used to fit the dose-response relationship, and mediated effects analysis was performed. [Results] The median plasma aluminum concentration (𝑃25,𝑃75 ) of the workers was 50.74 (23.45, 85.52) μg/L, the mean HRR was 11.87, the median MoCA total score (𝑃25,𝑃75 ) was 24.00 (22.00, 26.00). A dose-response relationship showed that the MoCA score decreased with increasing P-Al. After adjusting for demographic and lifestyle covariates, multiple linear regression showed that P-Al was negatively correlated with the HRR and MoCA score. For each unit increase in P-Al, the HRR decreased by an average of 0.17, and the total MoCA score decreased by an average of 0.9. HRR mediated 9.89% of the effect between P-Al and MoCA score. [Conclusion] Occupational aluminum exposure negatively affects workers' cognitive function and HRR levels. HRR can partially explain the effects of occupational aluminum exposure on workers' cognitive function.
Keywords: Occupational aluminum exposure, Cognitive Function, Blood indicators, Inflammatory markers, Mediating analysis
Received: 01 Jun 2025; Accepted: 03 Sep 2025.
Copyright: © 2025 Wang, Wang, Hu, Kong, Pei, Song, Lu and Pan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Baolong Pan, General hospital of TISCO, Taiyuan, China
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