Arsenic exposure is associated with pediatric pneumonia in rural Bangladesh: a case control study.
BACKGROUND
Pneumonia is the leading cause of death for children under 5 years of age globally, making research on modifiable risk factors for childhood pneumonia important for reducing this disease burden. Millions of children globally are exposed to elevated levels of arsenic in drinking water. However, there is limited data on the association between arsenic exposure and respiratory infections, particularly among pediatric populations.


METHODS
This case control study of 153 pneumonia cases and 296 controls 28 days to 59 months of age in rural Bangladesh is the first to assess whether arsenic exposure is a risk factor for pneumonia in a pediatric population. Cases had physician diagnosed World Health Organization defined severe or very severe pneumonia. Urine collected during hospitalization (hospital admission time point) and 30 days later (convalescent time point) from cases and a single specimen from community controls was tested for urinary arsenic by graphite furnace atomic absorption.


RESULTS
The odds for pneumonia was nearly double for children with urinary arsenic concentrations higher than the first quartile (≥6 μg/L) at the hospital admission time point (Odd Ratio (OR):1.88 (95% Confidence Interval (CI): 1.01, 3.53)), after adjustment for urinary creatinine, weight for height, breastfeeding, paternal education, age, and number of people in the household. This was consistent with findings at the convalescent time point where the adjusted OR for children with urinary arsenic concentrations greater than the first quartile (≥6 μg/L) was 2.32 (95% CI: 1.33, 4.02).


CONCLUSIONS
We observed a nearly two times higher odds of pneumonia for children with creatinine adjusted urinary arsenic concentrations greater than the first quartile (≥6 μg/L) at the hospital admission time point. This novel finding suggests that low to moderate arsenic exposure may be a risk factor for pneumonia in children under 5 years of age.
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. cgeorg19@jhu.edu.|Department of International Health, Program in Global Disease Epidemiology and Control, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E5535, Baltimore, MD, 21205-2103, USA. cgeorg19@jhu.edu.
Christine Marie
CM
George
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. abrooks@icddrb.org.|International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh. abrooks@icddrb.org.
W Abdullah
WA
Brooks
Department of Environmental Health, Mailman School of Public Health, Columbia University, New York, NY, USA. jg24@columbia.edu.
Joseph H
JH
Graziano
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. bnonyan1@jhu.edu.
Bareng A S
BA
Nonyane
International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh. lokman@icddrb.org.
Lokman
L
Hossain
International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh. drdolly@icddrb.org.
Doli
D
Goswami
International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh. kzaman@icddrb.org.
Khalequzzaman
K
Zaman
International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh. myunus@icddrb.org.
Mohammad
M
Yunus
International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh. fazal@icddrb.org.
Al Fazal
AF
Khan
International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh. dr.yasminjahan@gmail.com.
Yasmin
Y
Jahan
International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh. dahmed@icddrb.org.
Dilruba
D
Ahmed
Department of Environmental Health, Mailman School of Public Health, Columbia University, New York, NY, USA. vns1@cumc.columbia.edu.
Vesna
V
Slavkovich
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. mhigdon@jhu.edu.
Melissa
M
Higdon
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. mknoll2@jhu.edu.
Maria
M
Deloria-Knoll
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. kobrien2@jhu.edu.
Katherine L
KL
O' Brien
D001151:Arsenic / Q000633:toxicity*; D001459:Bangladesh / Q000453:epidemiology; D016022:Case-Control Studies; D002675:Child, Preschool; D060766:Drinking Water / Q000032:analysis*; D004781:Environmental Exposure; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D016017:Odds Ratio; D011014:Pneumonia / Q000453:epidemiology* / Q000209:etiology; D012307:Risk Factors; D012424:Rural Population; D014874:Water Pollutants, Chemical / Q000633:toxicity*
D060766:Drinking Water; D014874:Water Pollutants, Chemical; D001151:Arsenic