title: Inorganic arsenic and respiratory health, from early life exposure to sex-specific effects: A systematic review.
abstract: This systematic review synthesizes the diverse body of epidemiologic research accrued on inorganic arsenic exposure and respiratory health effects. Twenty-nine articles were identified that examined the relationship between inorganic arsenic exposure and respiratory outcomes (i.e. lung function, symptoms, acute respiratory infections, chronic non-malignant lung diseases, and non-malignant lung disease mortality). There was strong evidence of a general association between arsenic and non-malignant respiratory illness, including consistent evidence on lung function impairment, acute respiratory tract infections, respiratory symptoms, and non-malignant lung disease mortality. Overall, early life exposure (i.e. in utero and/or early-childhood) had a marked effect throughout the lifespan. This review also identified some research gaps, including limited evidence at lower levels of exposure (water arsenic <100μg/L), mixed evidence of sex differences, and some uncertainty on arsenic and any single non-malignant respiratory disease or pathological process. Common limitations, including potential publication bias; non-comparability of outcome measures across included articles; incomplete exposure histories; and limited confounder control attenuated the cumulative strength of the evidence as it relates to US populations. This systematic review provides a comprehensive assessment of the epidemiologic evidence and should be used to guide future research on arsenic's detrimental effects on respiratory health.
authors.affiliation: Department of Environmental Health Sciences, Columbia University, 722 West 168th Street, New York, NY 10032, USA. Electronic address: trs2111@cumc.columbia.edu.
authors.forename: Tiffany R
authors.initials: TR
authors.lastname: Sanchez
authors.affiliation: Department of Environmental Health Sciences, Columbia University, 722 West 168th Street, New York, NY 10032, USA. Electronic address: mp2217@cumc.columbia.edu.
authors.forename: Matthew
authors.initials: M
authors.lastname: Perzanowski
authors.affiliation: Department of Environmental Health Sciences, Columbia University, 722 West 168th Street, New York, NY 10032, USA. Electronic address: jg24@cumc.columbia.edu.
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Graziano
mesh_terms: D000367:Age Factors; D001151:Arsenic / Q000633:toxicity*; D006801:Humans; D008171:Lung Diseases / Q000139:chemically induced* / Q000401:mortality; D012129:Respiratory Function Tests; D012141:Respiratory Tract Infections / Q000139:chemically induced* / Q000453:epidemiology; D012737:Sex Factors
chemical_list: D001151:Arsenic
keywords: Arsenic; Drinking water; Epidemiology; Lung diseases; Systematic review