Arsenic-induced mortality from diseases of the respiratory system: Findings from the health effects of arsenic longitudinal study (HEALS)

摘要

The literature has documented an adverse effect of arsenic (As) exposure on the risk of respiratory symptoms, lung functions, obstructive pulmonary disease and levels of biomarkers for epithelial lung damage (Smith et al., 1998, 2006; Guo et al., 2007). For instance, a large number of papers from Bangladesh, India and China have reported adverse respiratory outcomes in populations drinking As-contaminated water (De et al., 2004; Guha Mazumder et al., 2000,2005; Milton and Rahman, 2002; Milton et al., 2003. At least six studies from India and Bangladesh showed signs of obstructive and restrictive lung disease and high prevalence of clinical respiratory symptoms such as chronic cough, abnormal chest sound, shortness of breath among people exposed to high levels of water As (>500 μg/L, Parvez et al., 2008) and with arsenical skin lesions; three of these studies were conducted in the same source population in India (von Ehren-stein et al., 2005). One study observed impaired lung functions such as lower FEV1 (Forced Expiratory Volume measured in 1 second) and FVC (Forced Vital Capacity) and another paper showed a ten-fold increased risk of chronic obstructive pulmonary disease (COPD) among people with arsenical skin lesions in India. A study from Inner Mongolia, reported a 13-fold increased risk for cough and a high prevalence of bronchitis among people living in As-exposed villages. However, little is known about the risk of mortality from lung diseases associated with chronic exposure to As from drinking water. To date, one report showed a high mortality from chronic obstructive pulmonary diseases (SMR: 7.6 and 95% CI, 3-15.6; p< 0.001) and bronchiectasis (SMR: 46.2 and 95% CI, 21.1-87.7; p < 0.001) among adults who were born during the high-exposure period in As endemic areas in Chile (1958-1970) with probable exposure in utero and early childhood.