Association between arsenic exposure from drinking water and hematuria: results from the Health Effects of Arsenic Longitudinal Study.
Arsenic (As) exposure has been associated with both urologic malignancy and renal dysfunction; however, its association with hematuria is unknown. We evaluated the association between drinking water As exposure and hematuria in 7843 men enrolled in the Health Effects of Arsenic Longitudinal Study (HEALS). Cross-sectional analysis of baseline data was conducted with As exposure assessed in both well water and urinary As measurements, while hematuria was measured using urine dipstick. Prospective analyses with Cox proportional regression models were based on urinary As and dipstick measurements obtained biannually since baseline up to six years. At baseline, urinary As was significantly related to prevalence of hematuria (P-trend<0.01), with increasing quintiles of exposure corresponding with respective prevalence odds ratios of 1.00 (reference), 1.29 (95% CI: 1.04-1.59), 1.41 (95% CI: 1.15-1.74), 1.46 (95% CI: 1.19-1.79), and 1.56 (95% CI: 1.27-1.91). Compared to those with relatively little absolute urinary As change during follow-up (-10.40 to 41.17 μg/l), hazard ratios for hematuria were 0.99 (95% CI: 0.80-1.22) and 0.80 (95% CI: 0.65-0.99) for those whose urinary As decreased by >47.49 μg/l and 10.87 to 47.49 μg/l since last visit, respectively, and 1.17 (95% CI: 0.94-1.45) and 1.36 (95% CI: 1.10-1.66) for those with between-visit increases of 10.40 to 41.17 μg/l and >41.17 μg/l, respectively. These data indicate a positive association of As exposure with both prevalence and incidence of dipstick hematuria. This exposure effect appears modifiable by relatively short-term changes in drinking water As.
Department of Population Health, New York University School of Medicine, New York, NY, USA; Department of Environmental Medicine, New York University School of Medicine, New York, NY, USA; Department of Urology, New York University School of Medicine, New York, NY, USA.
Tyler R
TR
McClintock
Department of Population Health, New York University School of Medicine, New York, NY, USA; Department of Environmental Medicine, New York University School of Medicine, New York, NY, USA. Electronic address: yu.chen@nyumc.org.
Yu
Y
Chen
Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA.
Faruque
F
Parvez
Department of Urology, New York University School of Medicine, New York, NY, USA; Robert F. Wagner Graduate School of Public Service, New York University, New York, NY, USA; United States Department of Veterans Affairs Harbor Healthcare System, New York, NY, USA; New York University Cancer Institute, New York, NY, USA.
Danil V
DV
Makarov
Department of Population Health, New York University School of Medicine, New York, NY, USA; Department of Environmental Medicine, New York University School of Medicine, New York, NY, USA.
Wenzhen
W
Ge
U-Chicago Research Bangladesh, Ltd., Dhaka, Bangladesh.
Tariqul
T
Islam
U-Chicago Research Bangladesh, Ltd., Dhaka, Bangladesh.
Alauddin
A
Ahmed
U-Chicago Research Bangladesh, Ltd., Dhaka, Bangladesh.
Muhammad
M
Rakibuz-Zaman
U-Chicago Research Bangladesh, Ltd., Dhaka, Bangladesh.
Rabiul
R
Hasan
U-Chicago Research Bangladesh, Ltd., Dhaka, Bangladesh.
Golam
G
Sarwar
Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA.
Vesna
V
Slavkovich
Department of Urology, New York University School of Medicine, New York, NY, USA.
Marc A
MA
Bjurlin
Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA.
Joseph H
JH
Graziano
Department of Health Studies, The University of Chicago, Chicago, IL, USA; Department of Medicine, The University of Chicago, Chicago, IL, USA; Department of Human Genetics, The University of Chicago, Chicago, IL, USA; Comprehensive Cancer Center, The University of Chicago, Chicago, IL, USA. Electronic address: habib@uchicago.edu.
Habibul
H
Ahsan
D000284:Administration, Oral; D000328:Adult; D001151:Arsenic / Q000008:administration & dosage / Q000032:analysis / Q000633:toxicity* / Q000652:urine; D020261:Arsenic Poisoning / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology / Q000652:urine; D001459:Bangladesh / Q000453:epidemiology; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D060766:Drinking Water / Q000009:adverse effects* / Q000737:chemistry; D006417:Hematuria / Q000209:etiology*; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008403:Mass Screening; D015995:Prevalence; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011934:Reagent Strips; D012423:Rural Health; D014874:Water Pollutants, Chemical / Q000008:administration & dosage / Q000032:analysis / Q000633:toxicity* / Q000652:urine; D060753:Water Quality; D060986:Water Wells / Q000737:chemistry
D060766:Drinking Water; D011934:Reagent Strips; D014874:Water Pollutants, Chemical; D001151:Arsenic
Arsenic; Bangladesh; Environmental epidemiology; Hematuria; Mass screening; Urologic neoplasms