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Arsenic in Drinking Water and Adult Mortality: A Population-based Cohort Study in Rural Bangladesh
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Internationell barnhälsa och nutrition/Persson)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Internationell barnhälsa och nutrition/Persson)
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2009 (English)In: Epidemiology, ISSN 1044-3983, E-ISSN 1531-5487, Vol. 20, no 6, 824-830 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:: Arsenic is a potent human carcinogen and toxicant. Elevated concentration of arsenic in drinking water is a major public-health problem worldwide. We evaluated risks of adult mortality (due to cancer and cardiovascular and infectious diseases) in relation to arsenic exposure through drinking water. METHODS:: A cohort analysis was applied to survival data prospectively collected during 1991-2000 in a health and demographic surveillance system in Matlab, Bangladesh, where tubewells were installed beginning in the early 1970s. A total of 115,903 persons aged 15 or more years on 1 January 1991 were available for analysis. In this period, 9015 people died and 22,488 were lost to follow-up. Arsenic exposure data were derived from a survey in 2002-2003 of past and current water use and arsenic concentrations in all tubewells. We estimated risk of excess mortality in relation to arsenic exposure, using proportional hazards models. RESULTS:: Even at low levels (10-49 mug/L) of arsenic in drinking water, we observed increased risk of death due to all nonaccidental causes (hazard ratio = 1.16 [95% confidence interval = 1.06-1.26]). Increased risks at exposure of 50-149 mug/L were observed for death due to cancers (1.44 [1.06-1.95]), cardiovascular disease (1.16 [0.96-1.40]), and infectious diseases (1.30 [1.13-1.49]). We observed clear dose-response relationships for each of these causes. CONCLUSIONS:: Arsenic exposure through drinking water has generated excess adult mortality after 20-30 years of exposure.

Place, publisher, year, edition, pages
2009. Vol. 20, no 6, 824-830 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-109016DOI: 10.1097/EDE.0b013e3181bb56ecISI: 000270874000008PubMedID: 19797964OAI: oai:DiVA.org:uu-109016DiVA: diva2:242200
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13Bibliographically approved
In thesis
1. Epidemiological and Spatial Association between Arsenic Exposure via Drinking Water and Morbidity and Mortality: Population based studies in rural Bangladesh
Open this publication in new window or tab >>Epidemiological and Spatial Association between Arsenic Exposure via Drinking Water and Morbidity and Mortality: Population based studies in rural Bangladesh
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis is to evaluate the risk for increased morbidity and mortality due to long-term arsenic exposure via drinking water by use of epidemiological and spatial approaches in studies performed in Matlab, Bangladesh. A total of 166,934 individuals aged 4 years and above were screened for skin lesions in 2002-2003. Another sample of 115,903 adults aged 15 years or more and a third sample of 26,972 pregnancies in 1991-2000 were considered in a historical cohort and an ecological study, respectively, where risk of adult mortality and spatial clusters of foetal loss and infant death were analysed in relation to arsenic exposure.

More than 70% of the tube-wells in the study area exceeded the threshold for arsenic contamination according to the WHO guideline (10 µg/L). The prevalence of arsenic-induced skin lesions was 3/1000 and men had significantly higher prevalence of skin lesions (SMR 158, 95% CI: 133-188) compared to women. There was an increased risk for death in adulthood due to all non-accidental causes (hazards ratio = 1.16, [95% CI 1.06-1.26]) even at a low level of arsenic contamination (10-49 µg/L). Slightly lower risks were observed for death in cancers (1.44 [1.06-1.95]) and infectious diseases (1.30 [1.13-1.49]) at 50-149 µg/L, but for cardiovascular diseases, it was evident (1.23 [1.01-1.51]) from the level 150-299 µg/L. A dose-response relationship was observed for each of these causes.

We identified high and low risk clusters of foetal loss and infant death that coincided with identified high and low clusters of arsenic exposure.

Water arsenic concentration of the reported main water source was significantly correlated with arsenic concentration in urine, which reflects current arsenic intake from all sources (R2=0.41, ρ< 0.0001), and the influence of neighbouring water sources was minimal.

The study findings underlines that the ongoing arsenic exposure has resulted in a series of severe public health consequences in Bangladesh that call for reinforcement in the mitigation efforts. Knowledge about the spatial distribution of exposure and health effects may be of value in that process.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2010. x, 51 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 549
Keyword
Arsenic, tube-well, skin lesion, adult mortality, foetal loss, infant death, cohort, spatial model, Bangladesh
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
International Health
Identifiers
urn:nbn:se:uu:diva-121788 (URN)978-91-554-7774-5 (ISBN)
Public defence
2010-05-17, Rosénsalen, Akademiska sjukhuset, 751 85 Uppsala, Ingång 95/96 nbv, 09:15 (English)
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Available from: 2010-04-22 Created: 2010-03-30 Last updated: 2010-04-22Bibliographically approved

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