title: Arsenic and lung disease mortality in Bangladeshi adults.
abstract: BACKGROUND
  Chronic arsenic exposure through drinking water is a public health problem affecting millions of people worldwide, including at least 30 million in Bangladesh. We prospectively investigated the associations of arsenic exposure and arsenical skin lesion status with lung disease mortality in Bangladeshi adults.
  
  
  METHODS
  Data were collected from a population-based sample of 26,043 adults, with an average of 8.5 years of follow-up (220,157 total person-years). There were 156 nonmalignant lung disease deaths and 90 lung cancer deaths ascertained through October 2013. We used Cox proportional hazards models to estimate adjusted hazard ratios and 95% confidence intervals (CIs) for lung disease mortality.
  
  
  RESULTS
  Creatinine-adjusted urinary total arsenic was associated with nonmalignant lung disease mortality, with persons in the highest tertile of exposure having a 75% increased risk for mortality (95% CI = 1.15-2.66) compared with those in the lowest tertile of exposure. Persons with arsenical skin lesions were at increased risk of lung cancer mortality (hazard ratio = 4.53 [95% CI = 2.82-7.29]) compared with those without skin lesions.
  
  
  CONCLUSIONS
  This prospective investigation of lung disease mortality, using individual-level arsenic measures and skin lesion status, confirms a deleterious effect of ingested arsenic on mortality from lung disease. Further investigations should evaluate effects on the incidence of specific lung diseases, more fully characterize dose-response, and evaluate screening and biomedical interventions to prevent premature death among arsenic-exposed populations, particularly among those who may be most susceptible to arsenic toxicity.
authors.affiliation: From the aDepartment of Health Studies, The University of Chicago, Chicago, IL; bDepartment of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY; cU-Chicago Research Bangladesh (URB), Ltd., Dhaka, Bangladesh; dPublic Health Sciences Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh; eDepartment of Environmental Medicine, New York University School of Medicine, New York, NY; fDepartments of Medicine and Family Medicine, The University of Chicago, Chicago, IL; gDepartment of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC; and hDepartments of Medicine and Human Genetics and Comprehensive Cancer Center, The University of Chicago, Chicago, IL.
authors.forename: Maria
authors.initials: M
authors.lastname: Argos
authors.forename: Faruque
authors.initials: F
authors.lastname: Parvez
authors.forename: Mahfuzar
authors.initials: M
authors.lastname: Rahman
authors.forename: Muhammad
authors.initials: M
authors.lastname: Rakibuz-Zaman
authors.forename: Alauddin
authors.initials: A
authors.lastname: Ahmed
authors.forename: Samar Kumar
authors.initials: SK
authors.lastname: Hore
authors.forename: Tariqul
authors.initials: T
authors.lastname: Islam
authors.forename: Yu
authors.initials: Y
authors.lastname: Chen
authors.forename: Brandon L
authors.initials: BL
authors.lastname: Pierce
authors.forename: Vesna
authors.initials: V
authors.lastname: Slavkovich
authors.forename: Christopher
authors.initials: C
authors.lastname: Olopade
authors.forename: Muhammad
authors.initials: M
authors.lastname: Yunus
authors.forename: John A
authors.initials: JA
authors.lastname: Baron
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Graziano
authors.forename: Habibul
authors.initials: H
authors.lastname: Ahsan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001151:Arsenic / Q000652:urine; D020261:Arsenic Poisoning / Q000401:mortality* / Q000473:pathology; D001459:Bangladesh / Q000453:epidemiology; D004781:Environmental Exposure / Q000009:adverse effects / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000139:chemically induced / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012867:Skin / Q000187:drug effects / Q000473:pathology; D055815:Young Adult
chemical_list: D001151:Arsenic