title: Increased childhood mortality and arsenic in drinking water in Matlab, Bangladesh: a population-based cohort study.
abstract: BACKGROUND
  Arsenic in drinking water was associated with increased risk of all-cause, cancer, and cardiovascular death in adults. However, the extent to which exposure is related to all-cause and deaths from cancer and cardiovascular condition in young age is unknown. Therefore, we prospectively assessed whether long-term and recent arsenic exposures are associated with all-cause and cancer and cardiovascular mortalities in Bangladeshi childhood population.
  
  
  RESULTS
  We assembled a cohort of 58406 children aged 5-18 years from the Health and Demographic Surveillance System of icddrb in Bangladesh and followed during 2003-2010. There were 185 non-accidental deaths registered in-about 0.4 million person-years of observation. We calculated hazard ratios for cause-specific death in relation to exposure at baseline (µg/L), time-weighted lifetime average (µg/L) and cumulative concentration (µg-years/L). After adjusting covariates, hazard ratios (HRs) for all-cause childhood deaths comparing lifetime average exposure 10-50.0, 50.1-150.0, 150.1-300.0 and ≥300.1µg/L were 1.37 (95% confidence interval [CI], 0.74-2.57), 1.44 (95% CI, 0.88-2.38), 1.22 (95% CI, 0.75-1.98) and 1.88 (95% CI, 1.14-3.10) respectively. Significant increased risk was also observed for baseline (P for trend = 0.023) and cumulative exposure categories (P for trend = 0.036). Girls had higher mortality risk compared to boys (HR for girls 1.79, 1.21, 1.64, 2.31; HR for boys 0.52, 0.53, 1.14, 0.99) in relation to baseline exposure. For all cancers and cardiovascular deaths combined, multivariable adjusted HRs amounted to 1.53 (95% CI 0.51-4.57); 1.29 (95% CI 0.43-3.87); 2.18 (95%CI 1.15-4.16) for 10.0-50.0, 50.1-150.0, and ≥150.1, comparing lowest exposure as reference (P for trend = 0.009). Adolescents had higher mortality risk compared to children (HRs = 1.53, 95% CI 1.03-2.28 vs. HRs = 1.30, 95% CI 0.78-2.17).
  
  
  CONCLUSIONS
  Arsenic exposure was associated with substantial increased risk of deaths at young age from all-cause, and cancers and cardiovascular conditions. Girls and adolescents (12-18 years) had higher risk compared to boys and child.
authors: icddrb, Mohakhali, Dhaka, Bangladesh. mahfuzar@icddrb.org
authors: Mahfuzar
authors: M
authors: Rahman
authors: Nazmul
authors: N
authors: Sohel
authors: Mohammad
authors: M
authors: Yunus
authors: Mahbub Elahi
authors: ME
authors: Chowdhury
authors: Samar Kumar
authors: SK
authors: Hore
authors: Khalequ
authors: K
authors: Zaman
authors: Abbas
authors: A
authors: Bhuiya
authors: Peter Kim
authors: PK
authors: Streatfield
mesh_terms: D000293:Adolescent; D000328:Adult; D001151:Arsenic / Q000032:analysis* / Q000633:toxicity; D001459:Bangladesh / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000139:chemically induced / Q000401:mortality*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D060766:Drinking Water / Q000737:chemistry*; D004781:Environmental Exposure / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000139:chemically induced / Q000401:mortality*; D018570:Risk Assessment; D012424:Rural Population / Q000706:statistics & numerical data*; D013997:Time Factors
chemical_list: D060766:Drinking Water; D001151:Arsenic
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