title: A prospective cohort study of stroke mortality and arsenic in drinking water in Bangladeshi adults.
abstract: BACKGROUND
  Arsenic in drinking water causes increased coronary artery disease (CAD) and death from CAD, but its association with stroke is not known.
  
  
  METHODS
  Prospective cohort study with arsenic exposure measured in well water at baseline. 61074 men and women aged 18 years or older on January 2003 were enrolled in 2003. The cohort was actively followed for an average of 7 years (421,754 person-years) through December 2010. Based on arsenic concentration the population was categorized in three groups and stroke mortality HR was compared to the referent. The risk of stroke mortality Hazard Ratio (HR) and 95% Confidence Interval was calculated in relation to arsenic exposure was estimated by Cox proportional hazard models with adjustment for potential confounders.
  
  
  RESULTS
  A total of 1033 people died from stroke during the follow-up period, accounting for 23% of the total deaths. Multivariable adjusted HRs (95% confidence interval) for stroke for well water arsenic concentrations <10, 10-49, and ≥50 μg/L were 1.0 (reference), 1.20 (0.92 to 1.57), and 1.35 (1.04 to 1.75) respectively (Ptrend=0.00058). For men, multivariable adjusted HRs (95%) for well water arsenic concentrations <10, 10-49, and ≥50 μg/L were 1.0 (reference), 1.12 (0.78 to 1.60), and 1.07 (0.75 to 1.51) respectively (Ptrend=0.45) and for women 1.0 (reference),1.31 (0.87 to 1.98), and 1.72 (1.15 to 2.57) respectively (Ptrend=0.00004).
  
  
  CONCLUSIONS
  The result suggests that arsenic exposure was associated with increased stroke mortality risk in this population, and was more significant in women compared to men.
authors.affiliation: ICDDRB, 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh. mahfuzar@icddrb.org.
authors.forename: Mahfuzar
authors.initials: M
authors.lastname: Rahman
authors.forename: Nazmul
authors.initials: N
authors.lastname: Sohel
authors.forename: Mohammad
authors.initials: M
authors.lastname: Yunus
authors.forename: Mahbub Elahi
authors.initials: ME
authors.lastname: Chowdhury
authors.forename: Samar Kumar
authors.initials: SK
authors.lastname: Hore
authors.forename: Khalequ
authors.initials: K
authors.lastname: Zaman
authors.forename: Abbas
authors.initials: A
authors.lastname: Bhuiya
authors.forename: Peter Kim
authors.initials: PK
authors.lastname: Streatfield
mesh_terms: D000293:Adolescent; D000328:Adult; D001151:Arsenic / Q000032:analysis; D020261:Arsenic Poisoning / Q000401:mortality*; D044466:Asian People; D001459:Bangladesh / Q000453:epidemiology; D015331:Cohort Studies; D003324:Coronary Artery Disease; D060766:Drinking Water / Q000032:analysis; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020521:Stroke / Q000209:etiology / Q000401:mortality*; D014874:Water Pollutants, Chemical / Q000633:toxicity*; D014881:Water Supply
chemical_list: D060766:Drinking Water; D014874:Water Pollutants, Chemical; D001151:Arsenic