Increased mortality from chronic diseases has been linked to long-term exposure to arsenic in drinking water. There is not much data, though, on correlations between lower exposure and mortality risk. Therefore, this study evaluated if decreases in arsenic exposure, assessed by urine arsenic levels, are related with decreased mortality from chronic illnesses, including cancer and cardiovascular disease (CVD).
In Araihazar, Bangladesh, a prospective cohort of 11,746 persons was enrolled between 2000 and 2002. The well-water arsenic levels ranged from less than 1 µg/L to 864 µg/L (mean, 102 µg/L), above the Bangladeshi threshold of 50 µg/L. As a consequence of community mitigation, arsenic levels gradually decreased. Through 2022, mortality was monitored. 10,977 persons with calculable increases in urine arsenic levels were included in the analyses.
Through 2018, the urine arsenic levels of each participants were assessed up to 5 times. Urinary arsenic levels were used to classify the participants. The main goal was to determine 95% CIs and adjusted hazard ratios (aHRs) for mortality from chronic illnesses, such as cancer and cardiovascular disease.
Between 2000 and 2018, the mean urine arsenic levels of 10,977 individuals (57% female; mean age, 37.0 [SD, 10.1] years) decreased from 283 (SD, 314) to 132 (SD, 161) µg/g creatinine. There was a 22% reduction in chronic disease mortality (aHR, 0.78 [95% CI, 0.75-0.82]), a 20% reduction in cancer mortality (aHR, 0.80 [95% CI, 0.73-0.87]), and a 23% reduction in CVD mortality (aHR, 0.77 [95% CI, 0.73-0.81]).
Larger decreases were connected to decreased mortality, whereas increases were linked to increased risk, according to time-varying Cox and limited cubic spline models. Those whose urinary arsenic levels fell below the median (n = 3757) had fewer deaths from chronic diseases (aHR, 0.46 [95% CI, 0.39-0.53]), including cancer (aHR, 0.51 [95% CI, 0.35-0.73]) and CVD (aHR, 0.43 [95% CI, 0.34-0.53]), comparable to those whose levels were consistently high (n = 1757) (aHR, 0.43-0.49).
Propensity score-matched analyses yielded comparable results. Overall, the results of this study corroborate the idea that communities exposed to tainted drinking water have better health outcomes when their exposure to arsenic is decreased.
Reference:
Wu, F., van Geen, A., Graziano, J., Ahmed, K. M., Liu, M., Argos, M., Parvez, F., Choudhury, I., Slavkovich, V. N., Ellis, T., Islam, T., Ahmed, A., Kibriya, M. G., Jasmine, F., Shahriar, M. H., Hasan, R., Shima, S. A., Sarwar, G., Navas-Acien, A., … Chen, Y. (2025). Arsenic exposure reduction and chronic disease mortality. The Journal of the American Medical Association, 334(23), 2104–2112. https://doi.org/10.1001/jama.2025.19161
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