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

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Abstract

Background

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.

Methods

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.

Results

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).

Conclusions

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.

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References

  • Agency for Toxic Substances and Disease Registry (ATSDR) (2007) Toxicological profile for Arsenic. US Department of Health and Human Services, Public Health Service, Atlanta

    Google Scholar 

  • Ahsan H, Chen Y, Parvez F, Zablotska L, Argos M, Hussain I et al (2006) Arsenic exposure from drinking water and risk of premalignant skin lesions in Bangladesh: baseline results from the Health Effects of Arsenic Longitudinal Study. Am J Epidemiol 163:1138–1148

    Article  Google Scholar 

  • Argos M, Kalra T, Pierce BL, Chen Y, Parvez F, Islam T et al (2011) A prospective study of arsenic exposure from drinking water and incidence of skin lesions in Bangladesh. Am J Epidemiol 174(2):185–194

    Article  Google Scholar 

  • Baastrup R, Sørensen M, Balstrøm T, Frederiksen K, Larsen CL, Tjønneland A et al (2008) Arsenic in drinking-water and risk for cancer in Denmark. Environ Health Perspect 116(2):231–237. https://doi.org/10.1289/ehp.10623

    Article  CAS  Google Scholar 

  • Bates MN, Rey OA, Biggs ML, Hopenhayn C, Moore LE, Kalman D et al (2004) Case-control study of bladder cancer and exposure to arsenic in Argentina. Am J Epidemiol 159(4):381–389

    Article  Google Scholar 

  • Bavazzano P, Perico A, Rosendahl H, Apostoli P (1996) Determination of urinary arsenic by solvent extraction and electrothermal atomic absorption spectrometry. A comparison with directly coupled high performance liquid chromatography-indiclively coupled plasma mass spectrometry. J Anal At Spectrom 11:521–524. https://doi.org/10.1039/JA9961100521

    Article  CAS  Google Scholar 

  • Begum M, Horowitz J, Hossain MI (2015) Low-dose risk assessment for arsenic: a meta-analysis approach. Asia Pac J Public Health 27(2):NP20–N35. https://doi.org/10.1177/1010539512466568

    Article  Google Scholar 

  • Bustaffa E, Minichilli F, Andreassi MG, Carone S, Coi A, Cori L et al (2014) Studies on markers of exposure and early effect in areas with arsenic pollution: methods and results of the project SEpiAs. Epidemiological surveillance in areas with environmental pollution by natural or anthropogenic arsenic. Epidemiol Prev 38(3–4 Suppl 1):27–94

    Google Scholar 

  • Celik I, Gallicchio L, Boyd K, Lam TK, Matanoski G, Tao X et al (2008) Arsenic in drinking water and lung cancer: a systematic review. Environ Res 108(1):48–55. https://doi.org/10.1016/j.envres.2008.04.001

    Article  CAS  Google Scholar 

  • Chen Y, Parvez F, Gamble M, Islam T, Ahmed A, Argos M et al (2009) Arsenic exposure at low-to-moderate levels and skin lesions, arsenic metabolism, neurological functions, and biomarkers for respiratory and cardiovascular diseases: review of recent findings from the Health Effects of Arsenic Longitudinal Study (HEALS) in Bangladesh. Toxicol Appl Pharmacol 239(2):184–192. https://doi.org/10.1016/j.taap.2009.01.010 (Epub 2009 Jan 27)

    Article  CAS  Google Scholar 

  • Chen CL, Chiou HY, Hsu LI, Hsueh YM, Wu MM, Wang YH et al (2010) Arsenic in drinking water and risk of urinary tract cancer: a follow-up study from northeastern Taiwan. Cancer Epidemiol Biomarkers Prev 19(1):101–110. https://doi.org/10.1158/1055-9965.EPI-09-0333

    Article  CAS  Google Scholar 

  • Engel RR, Smith AH (1994) Arsenic in drinking water and mortality from vascular disease: an ecologic analysis in 30 countries in the United States. Arch Environ Health 49(5):418–427

    Article  CAS  Google Scholar 

  • Ferreccio C, Gonzales C, Milosavjlevic V, Marshall G, Sancha AM, Smith AH (2000) Lung cancer and arsenic concentrations in drinking water in Chile. Epidemiology 11:673–679

    Article  CAS  Google Scholar 

  • Fine JP, Gray RJ (1999) A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc 94(446):496–509. https://doi.org/10.1080/01621459.1999.10474144

    Article  Google Scholar 

  • Guha Mazumder DN, Haque R, Ghosh N, De BH, Santra A, Chakraborty D et al (1998) Arsenic levels in drinking water and the prevalence of skin lesions in West Bengal, India. Int J Epidemiol 27(5):871–877

    Article  CAS  Google Scholar 

  • Han YY, Weissfeld JL, Davis DL, Talbott EO (2009) Arsenic levels in ground water and cancer incidence in Idaho: an ecologic study. Int Arch Occup Environ Health 82(7):843–849

    Article  CAS  Google Scholar 

  • Hartwig A, MAK Commission (2016) Arsenic and its inorganic compounds (with the Exception of Arsine), vol. 1. The Mak-Collection for Occupational Health and Safety: annual thresholds and classifications for the workplace. https://doi.org/10.1002/3527600418.mb744038vere5716

  • Hopenhayn-Rich C, Biggs ML, Fuchs A, Bergoglio R, Tello EE, Nicolli H et al (1996) Bladder cancer mortality associated with arsenic in drinking water in Argentina. Epidemiology 7(2):117–124

    Article  CAS  Google Scholar 

  • Hopenhayn-Rich C, Biggs ML, Smith AH (1998) Lung and kidney cancer mortality associated with arsenic in drinking water in Córdoba, Argentina. Int J Epidemiol 27(4):561–569

    Article  CAS  Google Scholar 

  • IARC (2012) Arsenic and arsenic compounds. IARC Monogr Eval Carcinog Risks Hum 100C:41–93

    Google Scholar 

  • Islam MR, Khan I, Attia J, Hassan SM, McEvoy M, D’Este C et al (2012) Association between hypertension and chronic arsenic exposure in drinking water: a cross-sectional study in Bangladesh. Int J Environ Res Public Health 9(12):4522–4536

    Article  CAS  Google Scholar 

  • Kurttio P, Pukkala E, Kahelin A, Auvinen A, Pekkanen J (1999) Arsenic concentrations in well water and risk of bladder and kidney cancer in Finland. Environ Health Perspect 107:705–710

    Article  CAS  Google Scholar 

  • Leonardi G, Vahter M, Clemens F, Goessler W, Gurzau E, Hemminki K et al (2012) Inorganic arsenic and basal cell carcinoma in areas of Hungary, Romania, and Slovakia: a case-control study. Environ Health Perspect 120(5):721–726. https://doi.org/10.1289/ehp.1103534 (Epub 2012 Jan 31)

    Article  CAS  Google Scholar 

  • Lewis DR, Southwick JW, Ouellet-Hellstrom R, Rench J, Calderon RL (1999) Drinking water arsenic in Utah: a cohort mortality study. Environ Health Perspect 107(5):359–365

    Article  CAS  Google Scholar 

  • Lisabeth LD, Ahn HJ, Chen JJ, Sealy-Jefferson S, Burke JF, Meliker JR (2010) Arsenic in drinking water and stroke hospitalisations in Michigan. Stroke 41(11):2499–2504

    Article  CAS  Google Scholar 

  • Maull EA, Ahsan H, Edwards J, Longnecker MP, Navas-Acien A, Pi J et al (2012) Evaluation of the association between arsenic and diabetes: a National Toxicology Program workshop review. Environ Health Perspect 120(12):1658–1670. https://doi.org/10.1289/ehp.1104579 (Epub 2012 Aug 10)

    Article  CAS  Google Scholar 

  • McDonald C, Hoque R, Huda N, Cherry N (2007) Risk of arsenic-related skin lesions in Bangladeshi villages at relatively low exposure: a report from Gonoshasthaya Kendra. Bull World Health Organ 85(9):668–673

    Article  Google Scholar 

  • Medrano MAJ, Boix R, Pastor-Barriuso R, Palau M, Damián J, Ramis R et al (2010) Arsenic in public water supplies and cardiovascular mortality in Spain. Environ Res 110:448–454

    Article  CAS  Google Scholar 

  • Minichilli F, Nuvolone D, Bustaffa E, Cipriani F, Vigotti MA, Bianchi F (2012) State of health of populations residing in geothermal areas of Tuscany. Epidemiol Prev 36(5 Suppl 1):1–104

    Google Scholar 

  • Mink PJ, Alexander DD, Barraj LM, Kelsh MA, Tsuji JS (2008) Low-level arsenic exposure in drinking water and bladder cancer: a review and meta-analysis. Regul Toxicol Pharmacol 52(3):299–310. https://doi.org/10.1016/j.yrtph.2008.08.010 (Epub 2008 Aug 26)

    Article  CAS  Google Scholar 

  • Moon K, Guallar E, Navas-Acien A (2012) Arsenic exposure and cardiovascular disease: an updated systematic review. Curr Atheroscler Rep 14(6):542–555. https://doi.org/10.1007/s11883-012-0280-x

    Article  CAS  Google Scholar 

  • Myers SL, Lobdell DT, Liu Z, Xia Y, Ren H, Li Y et al (2010) Maternal drinking water arsenic exposure and perinatal outcomes in inner Mongolia, China. J Epidemiol Community Health 64(4):325–329. https://doi.org/10.1136/jech.2008.084392 (Epub 2009 Aug 19)

    Article  CAS  Google Scholar 

  • Navas-Acien A, Silbergeld EK, Streeter RA, Clark JM, Burke TA, Guallar E (2006) Arsenic exposure and type 2 diabetes: a systematic review of the experimental and epidemiological evidence. Environ Health Perspect 114(5):641–648

    Article  CAS  Google Scholar 

  • Parvez F, Chen Y, Brandt-Rauf PW, Slavkovich V, Islam T, Ahmed A et al (2010) A prospective study of respiratory symptoms associated with chronic arsenic exposure in Bangladesh: findings from the Health Effects of Arsenic Longitudinal Study (HEALS). Thorax 65(6):528–533. https://doi.org/10.1136/thx.2009.119347

    Article  Google Scholar 

  • Rahman M, Vahter M, Sohel N, Yunus M, Wahed MA, Streatfield PK et al (2006) Arsenic exposure and age and sex-specific risk for skin lesions: a population-based case-referent study in Bangladesh. Environ Health Perspect 114(12):1847–1852

    Article  CAS  Google Scholar 

  • Sanchez TR, Perzanowski M, Graziano JH (2016) Inorganic arsenic and respiratory health, from early life exposure to sex-specific effects: a systematic review. Environ Res 147:537–555. https://doi.org/10.1016/j.envres.2016.02.009

    Article  CAS  Google Scholar 

  • Stea F, Faita F, Borghini A, Faita F, Bianchi F, Bustaffa E et al (2016) Arsenic and subclinical vascular damage in a sample of Italian young adults: a cross-sectional analysis. Environ Sci Pollut Res Int 23(20):20307–20314 (Epub 2016 Jul 23)

    Article  CAS  Google Scholar 

  • Wadhwa SK, Kazi TG, Chandio AA, Afridi HI, Kolachi NF, Khan S et al (2011) Comparative study of liver cancer patients in arsenic exposed and non-exposed areas of Pakistan. Biol Trace Elem Res 144(1–3):86–96. https://doi.org/10.1007/s12011-011-9036-7

    Article  CAS  Google Scholar 

  • WHO (1996) Biological monitoring of chemical exposure in the workplace, vol 1. World Health Organization, Geneva

    Google Scholar 

  • Xia Y, Wade TJ, Wu K, Li Y, Ning Z, Le XC et al (2009) Well water arsenic exposure, arsenic induced skin-lesions and self-reported morbidity in Inner Mongolia. Int J Environ Res Public Health 6(3):1010–1025

    Article  CAS  Google Scholar 

  • Yuan Y, Marshall G, Ferreccio C, Steinmaus C, Liaw J, Bates M et al (2010) Kidney cancer mortality: fifty-year latency patterns related to arsenic exposure. Epidemiology 21(1):103–108. https://doi.org/10.1097/EDE.0b013e3181c21e46

    Article  Google Scholar 

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Authors and Affiliations

  1. Regional Health Agency of Tuscany, via Pietro Dazzi 1, 50141, Florence, Italy

    Francesco Profili, Daniela Nuvolone & Fabio Voller

  2. Department of medicine, DAME Udine University, Udine, Italy

    Fabio Barbone

  3. Local Health Unit South East Tuscany, Siena, Italy

    Cristina Aprea, Letizia Centi & Riccardo Frazzetta

  4. National Institute of Health, Rome, Italy

    Stefano Belli

Authors
  1. Francesco Profili
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  2. Daniela Nuvolone
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  3. Fabio Barbone
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  4. Cristina Aprea
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  5. Letizia Centi
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  6. Riccardo Frazzetta
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  7. Stefano Belli
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  8. Fabio Voller
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Correspondence to Francesco Profili.

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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.

Additional information

Stefano Belli: currently retired.

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Profili, F., Nuvolone, D., Barbone, F. et al. Health effects among a cohort exposed to low-level arsenic in a geothermal area of Tuscany, Italy. Int Arch Occup Environ Health 91, 971–979 (2018). https://doi.org/10.1007/s00420-018-1340-5

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  • DOI: https://doi.org/10.1007/s00420-018-1340-5

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