Arsenic and Lung Disease Mortality in Bangladeshi Adults

Abstract

Background Chronic arsenic exposure through drinking water is a public health problem affecting millions of people worldwide, including at least 30 million in Bangladesh. We prospectively investigated the associations of arsenic exposure and arsenical skin lesion status with lung disease mortality in Bangladeshi adults. Methods Data are from a population-based sample of 26,043 adults, with an average of 8.5 years of follow-up (220,157 total person-years). There were 156 non-malignant lung disease deaths and 90 lung cancer deaths ascertained through October 2013. We used Cox proportional hazards models to estimate adjusted hazard ratios and 95% confidence intervals (CIs) for lung disease mortality. Results Creatinine-adjusted urinary total arsenic was associated with non-malignant lung disease mortality, with persons in the highest tertile of exposure having a 75% increased risk for mortality (95% CI=1.15–2.66) compared with those in the lowest tertile of exposure. Persons with arsenical skin lesions were at increased risk of lung cancer mortality (hazard ratio=4.53 [95% CI=2.82–7.29]) compared with those without skin lesions. Conclusions This prospective investigation of lung disease mortality, utilizing individual-level arsenic measures and skin lesion status, confirms a deleterious effect of ingested arsenic on mortality from lung disease. Further investigations should evaluate effects on the incidence of specific lung diseases, more fully characterize dose-response, and evaluate screening and biomedical interventions to prevent premature death among arsenic-exposed populations, particularly among those who may be most susceptible to arsenic toxicity.

Inorganic arsenic and respiratory health, from early life exposure to sex-specific effects: A systematic review

“…Results were similar for wAs. Although Argos et al (2014) did not capture early life InAs exposure, results from exposed populations in Antofagasta, Chile, with known lifetime exposure, show comparable findings. The 1998, 2006 and 2011 publications of Smith et al studied the same region in Chile.…”

“…Five publications examined InAs and non-malignant lung disease mortality (Argos et al, 2014; Smith et al, 2011, 2006; Tsai et al, 1999; Smith et al, 1998) (Table 6). Publications studied several relevant causes of death, including bronchiectasis, COPD, bronchitis, emphysema, pulmonary tuberculosis, and non-malignant lung disease (a combination of primary pulmonary hypertension and diseases of the respiratory system).…”

“…Tsai et al (1999), an ecological analysis in Taiwan, found significantly increased bronchitis mortality rates between 1971 and 1994, however it is possible that the findings may have been influenced by exposure misclassification, as there was greater variability of InAs in the exposure area. Argos et al (2014), a longitudinal analysis of over 26,000 adults with over 220,000 person-years of follow-up time, also found greater hazards of non-malignant lung disease mortality among participants with the highest tertile of creatinine-adjusted uAs (≥ 332 μg/g Cr) compared to those with the lowest tertile ( < 132.5 μg/g Cr), after adjusting for important potential confounders, including sex, age, BMI, education, and smoking (HR=1.75, 95% CI=1.15, 2.66). Results were similar for wAs.…”

A Meta-analysis of Arsenic Exposure and Lung Function: Is There Evidence of Restrictive or Obstructive Lung Disease?

“…3 There is also growing evidence that arsenic is associated with non-malignant respiratory disease. 4 Evidence from several populations, at different life stages, and at different levels of exposure (generally comparing levels higher than 100 μg/L versus lower exposures) showed consistent associations of chronic arsenic exposure with chronic lung disease mortality, 5–8 respiratory symptoms, 9,10 and lower lung function levels. 11–13 Although these epidemiologic observations provide supportive evidence of a link between arsenic and chronic lung disease morbidity and mortality, the specific pattern of lung disease associated with arsenic remains unclear.…”

An integrated study on Gammarus elvirae (Crustacea, Amphipoda): perspectives for toxicology of arsenic-contaminated freshwater

“…Indeed, this metalloid may pose a threat to public health, particularly in the long term. Exposure to inorganic forms of As has been associated with considerable adverse health effects, including cancers (Argos et al 2014;Faita et al 2013;Xie et al 2014).…”