Arsenic in drinking water and urinary tract cancers: a systematic review of 30 years of epidemiological evidence

Saint-Jacques, Nathalie; Parker, Louise; Brown, Patrick; Dummer, Trevor JB

doi:10.1186/1476-069X-13-44

Environmental Health

Table 5 Summary results from ecological studies reporting on arsenic exposure and kidney cancer

From: Arsenic in drinking water and urinary tract cancers: a systematic review of 30 years of epidemiological evidence

Study [reference] (Table from original publication)	Study locale	Outcome	Exposure¹[comments]	ICD²	Outcome measure	Cases	Risk estimate (95% CI)
Chen et al. 1985³[24] (Table One)	84 villages from 4 neighbouring townships on SW coast, Taiwan	Mortality 1968-82	Median arsenic content of artesian well and (range): 780 μg˙•L^-1 (350–1,140); in shallow well: 40 (0.0–300). Period of samples collection not reported.	ICD 189	SMR_male	42	7.72 (5.37–10.1)
Chen et al. 1985³[24] (Table One)		Mortality 1968-82	[Comparison of mortality rate in Blackfoot disease (BFD) with those of the general population.]	ICD 189	SMR_female	62	11.2 (8.38–14.0)
* Chen et al. 1988⁴[26] (Table One)	BFD endemic area, Taiwan	Mortality 1973-86	Arsenic well water concentration (μg˙•L^-1). Period of samples collection not reported.	ICD 189
			General population		ASMR_male	–	1.1
			General population			–	5.4
			< 300			–	13.1
			300-590			–	21.6
			≥ 600
			General population		ASMR_female	–	0.9
			General population			–	3.6
			< 300			–	12.5
			300-590			–	33.3
			≥ 600
			[Comparison of mortality rate in BFD with those of the general population.]
*Wu et al. 1989⁵[27] (Table Three)	BFD endemic area, Taiwan (42 villages)	Mortality 1973-86	Arsenic well water concentration (μg˙•L^-1) based on well water samples collected between 1964–66.	ICD8 189
			< 300		ASMR_male	9	8.42
			< 300			11	18.9
			300–590			6	25.3
			≥ 600
			< 300		ASMR_female	4	3.42
			< 300			13	19.4
			300–590			16	58.0
			≥ 600
Chen and Wang 1990⁶[28] (Table Four)	314 precincts & townships in Taiwan, including 4 from BFD endemic area	Mortality 1972-83	Average arsenic levels in water samples of all 314 geographical units. 73.9% had < 5% of wells with > 50 μg˙•L^-1 ; 14.7% had 5-14%; 11.5% had ≥ 15%. Well water samples collected between 1974–76.	ICD 189
			All precincts & townships		ASMR_male	–	1.1 (0.2)
			All precincts & townships		ASMR_female	–	1.7 (0.2)
			Southwestern townships		ASMR_male	–	1.2 (0.2)
			Southwestern townships		ASMR_female	–	1.7 (0.3)
Guo et al. 1997⁷[37] (Table Two)	243 townships in Taiwan	Incidence 1980-87	Arsenic well water concentration ranging from < 50 to > 640 μg˙•L-¹.	ICD 189.0, 189.1	RDmale	–	0.03 (0.02)
Guo et al. 1997⁷[37] (Table Two)	243 townships in Taiwan	Incidence 1980-87	Estimate presented measured at > 640 μg˙•L^-1. [Arsenic measurements from a National survey of 83,656 wells in 243 townships, collected mostly between 1974–76.]	ICD 189.0, 189.1	RDfemale	–	0.14 (0.013)
Rivara et al.1997 [38] (Table Four)	Chile	Mortality 1950-92	Annual average arsenic concentration in drinking water for Antofagasta (Region II of Chile) ranging between 40 to 860 μg˙•L^-1. Data from historical records from 1950–1992.	ICD 189	RR	–	3.8 (3.1–4.7)
Rivara et al.1997 [38] (Table Four)	Chile	Mortality 1950-92	[Comparison of mortality rate in Region II (exposed) populations vs Region VIII (control population.]	ICD 189	RR	–	3.8 (3.1–4.7)
Smith et al. 1998 [39]	Chile	Mortality 1989-93	Region II of Northern Chile with population weighted average arsenic concentration in drinking water up to 569 μg˙•L^-1 compared with the rest of Chile; exposure generally < 10 μg˙•L^-1.	N/A	SMR_male	39	1.6 (1.1–2.1)
Smith et al. 1998 [39]	Chile	Mortality 1989-93	[Arsenic measurements from 1950–94.]	N/A	SMR_female	34	2.7 (1.9–3.8)
Hinwood et al. 1999 [88] (Table Two)	22 areas in Victoria, Australia	Incidence 1982-91	Median water arsenic concentration ranging 13 μg˙•L^-1 to 1,077 μg˙•L^-1. [Selected areas were those where samples with soil and/or water arsenic concentration were generally in excess of 10 μg˙•L^-1. Period for samples collection is not available.]	ICD 189.0, 189.9	SIR	134	1.16 (0.98–1.37)
* Tsai et al. 1999 [41] (Tables Two, Three)	4 townships from BFD endemic area in SW coast, Taiwan	Mortality 1971-94	Median arsenic content of artesian well: 780 μg˙•L^-1 (range: 350–1,140).	ICD 189	SMR_local-male	94	6.76 (5.46–8.27)
					SMR_{national-male}	94	6.80 (5.49–8.32)
			Period of samples collection not reported. Authors state that artesian wells were no longer used by the mid-1970s.		SMR_local-female	128	8.89 (7.42–10.6)
			[Comparison of mortality in BFD endemic area with that of a local reference population (Chiayi-Tainan county) and that of Taiwan as a whole.]		SMR_{national-female}	128	10.5 (8.75–12.5)
*†Meliker et al. 2007 [90] (Table Two)	6 counties, Southeastern Michigan, USA	Mortality 1979-97	Population weighted median arsenic concentration in water of 7.58 μg˙•L^-1, with a range between 10–100 μg˙•L^-1. Data from 9,251 well water samples collected between 1983–2002.	ICD9 189	SMR_male	325	1.06 (0.91–1.22)
*†Meliker et al. 2007 [90] (Table Two)	6 counties, Southeastern Michigan, USA	Mortality 1979-97		ICD9 189	SMR_female	194	1.00 (0.82–1.20)
†Yuan et al. 2010 [61] (Tables Two, Three)	Region II and V, Chile	Mortality 1950-2000	Northern Chile (Region II) with population weighted average arsenic concentration in drinking water up to 569 μg˙•L^-1 vs Region V with exposure close to 1 μg˙•L^-1. Between 1958-70, arsenic concentration in water supply of Antofagasta and nearby Mejillones (Region II) averaged 870 μg˙•L^-1 and declined in 1970s when treatment plants were installed.	ICD9 189; ICD10 C64-C66, C68	Men and women aged 30+ years
					RR_{male-1950–54}	4	0.69 (0.23–2.02)
					RR_{male-1955–59}	9	1.43 (0.66–3.10)
					RR_{male-1960–64}	7	0.91 (0.40–2.08)
					RR_{male-1965–69}	12	2.51 (1.22–5.17)
					RR_{male1970–74}	15	1.45 (0.81–2.60)
					RR_{male1975–80}	19	2.13 (1.24–3.68)
					RR_{male1981–85}	39	3.37 (2.21–5.11)
					RR_{male1986–90}	63	2.81 (2.05–3.85)
					RR_{male1991–95}	50	1.78 (1.28–2.47)
					RR_{male1996–00}	66	1.61 (1.21–2.14)
					RR_{female-1950–54}	2	1.27 (0.27–6.00)
					RR_{female-1955–59}	2	0.30 (0.07–1.25)
					RR_{female-1960–64}	7	1.66 (0.71–3.91)
					RR_{female-1965–69}	3	0.76 (0.23–2.57)
					RR_{female1970–74}	13	3.70 (1.81–7.56)
					RR_{female1975–80}	9	1.71 (0.80–3.65)
					RR_{female1981–85}	25	2.89 (1.77–4.72)
					RR_{female1986–90}	41	3.23 (2.18–4.78)
					RR_{female1991–95}	49	4.37 (2.98–6.41)
					RR_{female1996–00}	47	2.32 (1.64–3.28)
					Young adults aged 30-39 years, born during and just before high-exposure period; and for ages 40+, born before 1950 with no early life exposure.
					SMR_{male_30-49 years}	4	5.63 (1.52–14.4)
					SMR_{male_40 years+}	103	2.68 (2.19–3.26)
					SMR^{female_30-49 years}	4	9.52 (2.56–24.4)
					SMR_{female_40 years+}	84	3.91 (3.12–4.84)
					SMR_{total_30-49 years}	8	7.08 (3.05–14.0)
					SMR_{total_40 years+}	187	3.12 (2.69–3.61)

*Study included in meta-analyses.
†Recent study not included in the International Agency for Research on Cancer 2012 review (Monograph 100C [23]).
¹All ecological studies assessed arsenic exposure at the group-level.
²ICD = International Classification of Disease. N/A = not available.
³SMR, standardized mortality ratio.
⁴Age-standardized mortality rates per 100,000 using the 1976 world population as standard population and based on 899,811 person-years.
⁵All age-standardardized mortality rates shown are significant at p < 0.001 based on trend test.
⁶Regression coefficient showing an increase in age-adjusted mortality per 100,000 persons-years for every 0.1 ppm increase in arsenic level, adjusting for indices of industrialization and urbanization. Standard errors are in brackets. Kidney cancer was significantly correlated with average arsenic level in water.
⁷RD, rate difference (per 100,000 person-years) for one unit increase in the predictor and associated standard error for exposure > 640 μg˙•L^-1(SE).

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ISSN: 1476-069X

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