Speaker
Description
Background: Tattoos and permanent make-up (PMU) gain increasing popularity, yet their potential systemic health implications remain poorly understood.
Methods: To investigate associations between tattoos/PMU and chronic disease outcomes, we analyzed data from the LIFE-Adult Study, a population-based cohort of 10,000 adults recruited in Leipzig, Germany (2011–2014). A dedicated tattoo-specific questionnaire was administered between June 2018 and December 2020 to 4,248 participants, of whom 7.4% (n = 320) reported tattoos or PMU (4.7% tattoos, 3.1% PMU, 14% both). The study was approved by the University of Leipzig Medical Faculty Ethics Board, with written informed consent obtained from all participants.
We examined liver toxicity and a composite cardiovascular disease (CVD) outcome (myocardial infarction or heart failure) supported by a biomarker for cardiac insufficiency NT-proBNP. Exposure data included tattoo/PMU characteristics (location, size, color, age). To address confounding, we constructed a directed acyclic graph (DAG) and applied full matching on age, sex, smoking status, body mass index, socioeconomic status, and alcohol consumption—maximizing data retention and enabling estimation of the average treatment effect on the treated (ATT) in the exposed group. Statistical analysis employed weighted logistic regression on matched data, with unweighted regression on unmatched data used for comparison.
Results: The prevalence of liver toxicity was 11.3% (23/203) among tattooed participants and 10% (382/3,944) among non-tattooed controls, with no association observed between tattoos/PMU size and liver enzyme elevation. We observed a sex-specific pattern so as the risk ratio for liver toxicity was 1.35 (95% CI [0.8–2.3]) in men and 0.43 (95% CI [0.2–0.91]) in women, a difference confirmed in unmatched analyses and persisting after excluding participants with hepatitis. The prevalence of CVD, was 5.4% (15/278) among tattooed individuals, compared to 5.1% (201/3,972) in non-tattooed controls, with a risk ratio of 1.2 (95% CI [0.7–2.1]) in the matched cohort and 1.1 (95% CI [0.7–1.8]) in unmatched analyses. NT-proBNP levels, were similarly elevated in both groups (6.4% in tattooed vs. 6.4% in non-tattooed), yielding a risk ratio of 0.8 (95% CI [0.4–1.6]).
Discussion: Our findings suggest a potential sex-modulated association between tattoos and liver toxicity. Cardiovascular outcomes showed an increased risk as well. Weighted models provided more stable estimates. Notably, sex-specific patterns emerged though limited power in the female subgroup constrained inference. Despite the small sample size, elevated risk ratios for cardiovascular disease and liver toxicity suggest a need for other longitudinal studies of the health effect of tattoos.
21429417717