Nickel and Dimed: How a Common Earth Element is Short-Changing Our Health

Nickel has been studied for a long time as an environmental contaminant but less so in its connection to population health. It does not announce itself as loudly as its transition metal brethren like mercury and cadmium, but its chemical properties permit it to be deleterious as a low-dose, chronic exposure, particularly among those with immune systems sensitized to it. There is a growing evidence base and vocabulary to discuss nickel's affect on health. However, in the U.S., there are not recent, reliable estimates of the share of the population with a nickel allergy, let alone how much nickel Americans are exposed to through their diet. This paper seeks to close this evidence gap by creating a new dataset of dietary nickel and other heavy metal exposure and assessing how high levels of dietary nickel exposure shape local demand for health care services. We use soil data from the U.S. Geological Survey and data on agricultural product transport from FoodFlows.org to create a county-level dietary nickel exposure index. We then use a large electronic health record database and double machine learning to estimate how demand for primary care services varies across levels of dietary nickel exposure. We find that counties with high nickel exposure experience an increase in the share of primary care office visits for symptoms highly suggestive of nickel poisoning. This result survives multiple hypothesis test corrections and placebo tests. Our research suggests that nickel has harmful effects on individual health whose exposure can be measured at a population level, and is shaping primary care across the U.S.