Arsenic exposure and young adult's mortality risk: A 13-year follow-up study in Matlab, Bangladesh

Mahfuzar Rahman; Nazmul Sohel; Fakir Md Yunus; Nurul Alam; Qamrun Nahar; Peter Kim Streatfield; Mohammad Yunus

doi:10.1016/j.envint.2018.12.006

Arsenic exposure and young adult's mortality risk: A 13-year follow-up study in Matlab, Bangladesh

Environ Int. 2019 Feb:123:358-367. doi: 10.1016/j.envint.2018.12.006. Epub 2018 Dec 18.

Authors

Mahfuzar Rahman¹, Nazmul Sohel², Fakir Md Yunus³, Nurul Alam⁴, Qamrun Nahar⁴, Peter Kim Streatfield⁴, Mohammad Yunus⁴

Affiliations

¹ Research and Evaluation Division, BRAC, BRAC Centre, 75 Mohakhali, Dhaka 1212, Bangladesh. Electronic address: mahfuzar.rahman@brac.net.
² Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada.
³ Research and Evaluation Division, BRAC, BRAC Centre, 75 Mohakhali, Dhaka 1212, Bangladesh.
⁴ ICDDRB, 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh.

PMID: 30562707
DOI: 10.1016/j.envint.2018.12.006

Abstract

Background: Widespread arsenic contamination in underground water is a well-documented public health concern that threatens millions of lives worldwide. We investigated the risk of young-adult mortality due to high chronic exposure to arsenic through years of drinking arsenic contaminated water.

Methods: A prospective cohort study of 58,406 individuals was enrolled who were 4-18 years at baseline. Since Matlab HDSS (Health and Demographic Surveillance System) has an active surveillance system, all individuals were included in the follow up. Each individual's arsenic exposure was calculated at (1) baseline As level as current exposure (2) time-weighted lifetime (average or lifetime average) and (3) cumulative arsenic exposure. Age, sex, educational attainment and SES were adjusted during the analysis. In this 13 years closed-cohort study (2003-2015), all young-adult deaths were captured through verbal autopsy (VA) using International Classification of Diseases (ICD-10) to define the causes.

Results: Although, girls had higher values of cumulative arsenic exposure via tube well water than boys (median: 1858.5 μg/year/L vs. 1798.8 μg/year/L) but higher mortality due to cancers and due to cerebro-vascular disease, cardio-vascular disease, and respiratory disease (7.0 vs. 5.7 per 100,000 person-years and 6.4 vs. 4.2 per 100,000 person-years respectively). Higher risk of deaths among young adults (Adjusted HR: 2.7, 1.3-5.8) due to all cancers among those who were exposed to As > 138.7 compared to As ≤ 1.1 μg/L. For cerebro-vascular disease, cardio-vascular disease, and respiratory disease deaths, average arsenic in well water (>223.1 μg/L vs. ≤90.9 μg/L) and cumulative arsenic in well water (>2711.0 μg/year/L vs. ≤1013.3 μg/year/L) had 4.8 (1.8-12.8) and 5.1 (1.7-15.1) times higher risks of mortality than to those lowest exposed.

Conclusion: Higher concentration of, and chronic exposure to arsenic in drinking water, increases the mortality risk among the young adults, regardless of gender.

Keywords: Arsenic exposure; Global health; Ground water; Toxicity.

Publication types

Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Adolescent
Arsenic / analysis
Arsenic / toxicity*
Bangladesh / epidemiology
Cause of Death
Child
Cohort Studies
Drinking Water / chemistry*
Environmental Exposure*
Female
Follow-Up Studies
Humans
Male
Mortality*
Neoplasms / mortality
Prospective Studies
Water Pollutants, Chemical / analysis
Water Pollutants, Chemical / toxicity*
Water Wells

Substances

Drinking Water
Water Pollutants, Chemical
Arsenic