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. 2011 Feb 15;173(4):414-20.
doi: 10.1093/aje/kwq383. Epub 2010 Dec 29.

Evidence from Chile that arsenic in drinking water may increase mortality from pulmonary tuberculosis

Allan H Smith  1 , Guillermo Marshall, Yan Yuan, Jane Liaw, Catterina Ferreccio, Craig Steinmaus
Affiliations

Evidence from Chile that arsenic in drinking water may increase mortality from pulmonary tuberculosis

Allan H Smith et al. Am J Epidemiol. .

Abstract

Arsenic in drinking water causes increased mortality from several cancers, ischemic heart disease, bronchiectasis, and other diseases. This paper presents the first evidence relating arsenic exposure to pulmonary tuberculosis, by estimating mortality rate ratios for Region II of Chile compared with Region V for the years 1958-2000. The authors compared mortality rate ratios with time patterns of arsenic exposure, which increased abruptly in 1958 in Region II and then declined starting in 1971. Tuberculosis mortality rate ratios in men started increasing in 1968, 10 years after high arsenic exposure commenced. The peak male 5-year mortality rate ratio occurred during 1982-1986 (rate ratio = 2.1, 95% confidence interval: 1.7, 2.6; P < 0.001) and subsequently declined. Mortality rates in women were also elevated but with fewer excess pulmonary tuberculosis deaths (359 among men and 95 among women). The clear rise and fall of tuberculosis mortality rate ratios in men following high arsenic exposure are consistent with a causal relation. The findings are biologically plausible in view of evidence that arsenic is an immunosuppressant and also a cause of chronic lung disease. Finding weaker associations in women is unsurprising, because this is true of most arsenic-caused health effects. Confirmatory evidence is needed from other arsenic-exposed populations.

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Figures

Figure 1.
Figure 1.
Map of Chile.
Figure 2.
Figure 2.
Arsenic concentrations in water by year, Antofagasta and Mejillones, Chile, 1950–2000. New arsenic-contaminated water sources were used from 1958 onward, and an arsenic removal plant was installed in 1971.
Figure 3.
Figure 3.
Age-adjusted rate ratios and 95% confidence intervals for pulmonary tuberculosis mortality for men of all ages, Region II (exposed) compared with Region V (unexposed), Chile, 1958–2000. Each point represents an estimate for 5 years and is plotted at the midpoint of the 5-year period, starting with the estimate for 1958–1962, which is plotted at the year 1960.
See this image and copyright information in PMC

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