Health effects among a cohort exposed to low-level arsenic in a geothermal area of Tuscany, Italy

  • Francesco Profili
  • Daniela Nuvolone
  • Fabio Barbone
  • Cristina Aprea
  • Letizia Centi
  • Riccardo Frazzetta
  • Stefano Belli
  • Fabio Voller
Original Article



Studies on low-level As exposure have not found an association with cancer, while increased risks were reported for skin lesions, respiratory and cardiovascular diseases and reproductive outcomes. Prospective observational studies with individual exposure measures are needed to study low-level As exposure effects. In a geothermal area in Southern Tuscany (Italy), characterized by a natural presence of As in drinking water (< 50 µg/l), As urinary concentrations were measured in a survey in 1998 and cohort members were followed to evaluate the effects on health.


Around 900 subjects (20–55 years old) randomly sampled in 4 municipalities of the area (Monte Amiata), have been followed from 1999 to 2015, by hospitalisation and mortality registries. Standardized Hospitalisation Ratios (SHRs) were performed, compared to a reference area. Competing-risks regression models were performed to test the association between As urinary concentration and risk of first hospitalisation.


SHRs show various increased risks, more frequently among males. Internal analyses show a positive association between As and skin diseases in the general population, the Hazard Ratio (HR) for 1 µg/l increase of As urinary concentration is 1.06 (90%CI 1.01–1.11) and in males, HR 1.08 (90%CI 1.02–1.14), between As and circulatory system diseases in males, HR 1.03 (90%CI 1.01–1.05).


The results suggest an effect on skin diseases and circulatory system diseases and, considering the relative young age of cohort members, they could be considered also as predictive of future severer diseases.


Arsenic Low-level exposure Cohort Metal 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Regional Health Agency of TuscanyFlorenceItaly
  2. 2.Department of medicineDAME Udine UniversityUdineItaly
  3. 3.Local Health Unit South East TuscanySienaItaly
  4. 4.National Institute of HealthRomeItaly

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