Arsenic exposure from drinking water, and all-cause and chronic-disease mortalities in Bangladesh (HEALS): A prospective cohort study

Maria Argos, Tara Kalra, Paul J. Rathouz, Yu Chen, Brandon Pierce, Faruque Parvez, Tariqul Islam, Alauddin Ahmed, Muhammad Rakibuz-Zaman, Rabiul Hasan, Golam Sarwar, Vesna Slavkovich, Alexander Van Geen, Joseph Graziano, Habibul Ahsan

Research output: Contribution to journalArticle

Abstract

Background Millions of people worldwide are chronically exposed to arsenic through drinking water, including 35-77 million people in Bangladesh. The association between arsenic exposure and mortality rate has not been prospectively investigated by use of individual-level data. We therefore prospectively assessed whether chronic and recent changes in arsenic exposure are associated with all-cause and chronic-disease mortalities in a Bangladeshi population. Methods In the prospective cohort Health Effects of Arsenic Longitudinal Study (HEALS), trained physicians unaware of arsenic exposure interviewed in person and clinically assessed 11 746 population-based participants (aged 18-75 years) from Araihazar, Bangladesh. Participants were recruited from October, 2000, to May, 2002, and followed-up biennially. Data for mortality rates were available throughout February, 2009. We used Cox proportional hazards model to estimate hazard ratios (HRs) of mortality, with adjustment for potential confounders, at different doses of arsenic exposure. Findings 407 deaths were ascertained between October, 2000, and February, 2009. Multivariate adjusted HRs for all-cause mortality in a comparison of arsenic at concentrations of 10.1-50.0 μg/L, 50.1-150.0 μg/L, and 150.1-864.0 μg/L with at least 10.0 μg/L in well water were 1.34 (95% CI 0.99-1.82), 1.09 (0.81-1.47), and 1.68 (1.26-2.23), respectively. Results were similar with daily arsenic dose and total arsenic concentration in urine. Recent change in exposure, measurement of total arsenic concentrations in urine repeated biennially, did not have much effect on the mortality rate. Interpretation Chronic arsenic exposure through drinking water was associated with an increase in the mortality rate. Follow-up data from this cohort will be used to assess the long-term effects of arsenic exposure and how they might be affected by changes in exposure. However, solutions and resources are urgently needed to mitigate the resulting health effects of arsenic exposure.

Original languageEnglish (US)
Pages (from-to)252-258
Number of pages7
JournalThe Lancet
Volume376
Issue number9737
DOIs
StatePublished - 2010

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Bangladesh
Arsenic
Drinking Water
Longitudinal Studies
Chronic Disease
Cohort Studies
Prospective Studies
Mortality
Health
Urine
Cohort Effect
Proportional Hazards Models
Population

ASJC Scopus subject areas

  • Medicine(all)

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Arsenic exposure from drinking water, and all-cause and chronic-disease mortalities in Bangladesh (HEALS) : A prospective cohort study. / Argos, Maria; Kalra, Tara; Rathouz, Paul J.; Chen, Yu; Pierce, Brandon; Parvez, Faruque; Islam, Tariqul; Ahmed, Alauddin; Rakibuz-Zaman, Muhammad; Hasan, Rabiul; Sarwar, Golam; Slavkovich, Vesna; Van Geen, Alexander; Graziano, Joseph; Ahsan, Habibul.

In: The Lancet, Vol. 376, No. 9737, 2010, p. 252-258.

Research output: Contribution to journalArticle

Argos, M, Kalra, T, Rathouz, PJ, Chen, Y, Pierce, B, Parvez, F, Islam, T, Ahmed, A, Rakibuz-Zaman, M, Hasan, R, Sarwar, G, Slavkovich, V, Van Geen, A, Graziano, J & Ahsan, H 2010, 'Arsenic exposure from drinking water, and all-cause and chronic-disease mortalities in Bangladesh (HEALS): A prospective cohort study', The Lancet, vol. 376, no. 9737, pp. 252-258. https://doi.org/10.1016/S0140-6736(10)60481-3
Argos, Maria ; Kalra, Tara ; Rathouz, Paul J. ; Chen, Yu ; Pierce, Brandon ; Parvez, Faruque ; Islam, Tariqul ; Ahmed, Alauddin ; Rakibuz-Zaman, Muhammad ; Hasan, Rabiul ; Sarwar, Golam ; Slavkovich, Vesna ; Van Geen, Alexander ; Graziano, Joseph ; Ahsan, Habibul. / Arsenic exposure from drinking water, and all-cause and chronic-disease mortalities in Bangladesh (HEALS) : A prospective cohort study. In: The Lancet. 2010 ; Vol. 376, No. 9737. pp. 252-258.
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abstract = "Background Millions of people worldwide are chronically exposed to arsenic through drinking water, including 35-77 million people in Bangladesh. The association between arsenic exposure and mortality rate has not been prospectively investigated by use of individual-level data. We therefore prospectively assessed whether chronic and recent changes in arsenic exposure are associated with all-cause and chronic-disease mortalities in a Bangladeshi population. Methods In the prospective cohort Health Effects of Arsenic Longitudinal Study (HEALS), trained physicians unaware of arsenic exposure interviewed in person and clinically assessed 11 746 population-based participants (aged 18-75 years) from Araihazar, Bangladesh. Participants were recruited from October, 2000, to May, 2002, and followed-up biennially. Data for mortality rates were available throughout February, 2009. We used Cox proportional hazards model to estimate hazard ratios (HRs) of mortality, with adjustment for potential confounders, at different doses of arsenic exposure. Findings 407 deaths were ascertained between October, 2000, and February, 2009. Multivariate adjusted HRs for all-cause mortality in a comparison of arsenic at concentrations of 10.1-50.0 μg/L, 50.1-150.0 μg/L, and 150.1-864.0 μg/L with at least 10.0 μg/L in well water were 1.34 (95{\%} CI 0.99-1.82), 1.09 (0.81-1.47), and 1.68 (1.26-2.23), respectively. Results were similar with daily arsenic dose and total arsenic concentration in urine. Recent change in exposure, measurement of total arsenic concentrations in urine repeated biennially, did not have much effect on the mortality rate. Interpretation Chronic arsenic exposure through drinking water was associated with an increase in the mortality rate. Follow-up data from this cohort will be used to assess the long-term effects of arsenic exposure and how they might be affected by changes in exposure. However, solutions and resources are urgently needed to mitigate the resulting health effects of arsenic exposure.",
author = "Maria Argos and Tara Kalra and Rathouz, {Paul J.} and Yu Chen and Brandon Pierce and Faruque Parvez and Tariqul Islam and Alauddin Ahmed and Muhammad Rakibuz-Zaman and Rabiul Hasan and Golam Sarwar and Vesna Slavkovich and {Van Geen}, Alexander and Joseph Graziano and Habibul Ahsan",
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T1 - Arsenic exposure from drinking water, and all-cause and chronic-disease mortalities in Bangladesh (HEALS)

T2 - A prospective cohort study

AU - Argos, Maria

AU - Kalra, Tara

AU - Rathouz, Paul J.

AU - Chen, Yu

AU - Pierce, Brandon

AU - Parvez, Faruque

AU - Islam, Tariqul

AU - Ahmed, Alauddin

AU - Rakibuz-Zaman, Muhammad

AU - Hasan, Rabiul

AU - Sarwar, Golam

AU - Slavkovich, Vesna

AU - Van Geen, Alexander

AU - Graziano, Joseph

AU - Ahsan, Habibul

PY - 2010

Y1 - 2010

N2 - Background Millions of people worldwide are chronically exposed to arsenic through drinking water, including 35-77 million people in Bangladesh. The association between arsenic exposure and mortality rate has not been prospectively investigated by use of individual-level data. We therefore prospectively assessed whether chronic and recent changes in arsenic exposure are associated with all-cause and chronic-disease mortalities in a Bangladeshi population. Methods In the prospective cohort Health Effects of Arsenic Longitudinal Study (HEALS), trained physicians unaware of arsenic exposure interviewed in person and clinically assessed 11 746 population-based participants (aged 18-75 years) from Araihazar, Bangladesh. Participants were recruited from October, 2000, to May, 2002, and followed-up biennially. Data for mortality rates were available throughout February, 2009. We used Cox proportional hazards model to estimate hazard ratios (HRs) of mortality, with adjustment for potential confounders, at different doses of arsenic exposure. Findings 407 deaths were ascertained between October, 2000, and February, 2009. Multivariate adjusted HRs for all-cause mortality in a comparison of arsenic at concentrations of 10.1-50.0 μg/L, 50.1-150.0 μg/L, and 150.1-864.0 μg/L with at least 10.0 μg/L in well water were 1.34 (95% CI 0.99-1.82), 1.09 (0.81-1.47), and 1.68 (1.26-2.23), respectively. Results were similar with daily arsenic dose and total arsenic concentration in urine. Recent change in exposure, measurement of total arsenic concentrations in urine repeated biennially, did not have much effect on the mortality rate. Interpretation Chronic arsenic exposure through drinking water was associated with an increase in the mortality rate. Follow-up data from this cohort will be used to assess the long-term effects of arsenic exposure and how they might be affected by changes in exposure. However, solutions and resources are urgently needed to mitigate the resulting health effects of arsenic exposure.

AB - Background Millions of people worldwide are chronically exposed to arsenic through drinking water, including 35-77 million people in Bangladesh. The association between arsenic exposure and mortality rate has not been prospectively investigated by use of individual-level data. We therefore prospectively assessed whether chronic and recent changes in arsenic exposure are associated with all-cause and chronic-disease mortalities in a Bangladeshi population. Methods In the prospective cohort Health Effects of Arsenic Longitudinal Study (HEALS), trained physicians unaware of arsenic exposure interviewed in person and clinically assessed 11 746 population-based participants (aged 18-75 years) from Araihazar, Bangladesh. Participants were recruited from October, 2000, to May, 2002, and followed-up biennially. Data for mortality rates were available throughout February, 2009. We used Cox proportional hazards model to estimate hazard ratios (HRs) of mortality, with adjustment for potential confounders, at different doses of arsenic exposure. Findings 407 deaths were ascertained between October, 2000, and February, 2009. Multivariate adjusted HRs for all-cause mortality in a comparison of arsenic at concentrations of 10.1-50.0 μg/L, 50.1-150.0 μg/L, and 150.1-864.0 μg/L with at least 10.0 μg/L in well water were 1.34 (95% CI 0.99-1.82), 1.09 (0.81-1.47), and 1.68 (1.26-2.23), respectively. Results were similar with daily arsenic dose and total arsenic concentration in urine. Recent change in exposure, measurement of total arsenic concentrations in urine repeated biennially, did not have much effect on the mortality rate. Interpretation Chronic arsenic exposure through drinking water was associated with an increase in the mortality rate. Follow-up data from this cohort will be used to assess the long-term effects of arsenic exposure and how they might be affected by changes in exposure. However, solutions and resources are urgently needed to mitigate the resulting health effects of arsenic exposure.

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