title: Effects of Arsenic in Drinking Water on Risk of Hepatitis or Cirrhosis in Persons With and Without Chronic Viral Hepatitis.
abstract: Arsenic in drinking water is associated with hepatomegaly and death from liver cancer. However, confounding factors related to liver diseases have not been carefully studied. We examined associations between exposure of arsenic in drinking water and risk of hepatitis and cirrhosis, and the interaction with chronic viral hepatitis, in people living in the Lanyang Basin of northeastern Taiwan, where well water has an arsenic content that ranges from undetectable to 3590 μg/L.
  
  
  
  We tested blood samples from 4387 people who lived in arseniasis-endemic areas in northeastern Taiwan from 1991 through 1994 for hepatitis B virus DNA, hepatitis B surface antigen (HBsAg), and antibodies against hepatitis C virus (anti-HCV). We measured arsenic concentrations in well water and collected information on residents' histories of major chronic diseases. Reports of chronic hepatitis or cirrhosis were ascertained using the Taiwan National Health Insurance database. Reports of liver cancer were ascertained using the Taiwan National Cancer Registry.
  
  
  
  Prevalence odds ratios in the overall study population for chronic hepatitis or cirrhosis for well water arsenic concentrations of ≤10 μg/L were 1.00 (reference), 0.93 for 10.1-49.9 μg/L (95% confidence interval [CI], 0.57-1.52), 1.24 for 50.0-99.9 μg/L (95% CI, 0.68-2.23), 0.98 for 100.0-299.9 (95% CI, 0.52-1.85), and 1.86 for ≥300.0 μg/L (95% CI, 1.08-3.20). Increasing levels of arsenic in drinking water were associated with increasing prevalence of chronic hepatitis or cirrhosis in residents who were seronegative for HBsAg and seronegative for anti-HCV, but not for seropositive for either HBsAg or anti-HCV. In individuals who were seropositive for HBsAg or anti-HCV, we observed an inverse association between hepatitis or cirrhosis and consumption of water with levels of arsenic ≥100.0 μg/L. Among participants who were seropositive for HBsAg or anti-HCV, consumption of water with levels of arsenic ≥100.0 μg/L was associated with a reduced risk of liver cancer (multivariate-adjusted hazard ratio, 0.29; 95% CI, 0.09-0.95; P < .05). A higher proportion of individuals exposed to cumulative arsenic level >14,000 μg/L ×year were carriers of inactive hepatitis B virus (DNA <10,000 copies/mL) and were positive for HBsAg (60%) than individuals exposed to water below this arsenic level (35%).
  
  
  
  Concentrations of arsenic concentration in drinking water ≥300.0 μg/L significantly increase risk of hepatitis or cirrhosis in people without chronic viral hepatitis. However, in people with chronic viral hepatitis, levels of arsenic ≥100.0 μg/L in drinking water significantly reduce the risk of chronic hepatitis or cirrhosis.
authors.affiliation: Genomics Research Center, Academia Sinica, Taipei, Taiwan; Department of Health Care Management, Chang-Gung University, Taoyuan City, Taiwan.
authors.forename: Ling-I
authors.initials: LI
authors.lastname: Hsu
authors.affiliation: Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Medical Research, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
authors.forename: Yuan-Hung
authors.initials: YH
authors.lastname: Wang
authors.affiliation: School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan.
authors.forename: Fang-I
authors.initials: FI
authors.lastname: Hsieh
authors.affiliation: Molecular and Genomic Epidemiology Center, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Tse-Yen
authors.initials: TY
authors.lastname: Yang
authors.affiliation: Department of Gastroenterology and Hepatology, Division of Hepatology Chang Gung Medical Foundation, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Rachel
authors.initials: R
authors.lastname: Wen-Juei Jeng
authors.affiliation: Yilan Public Health Bureau, Yilan City, Taiwan.
authors.forename: Chien-Ting
authors.initials: CT
authors.lastname: Liu
authors.affiliation: Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Chi-Ling
authors.initials: CL
authors.lastname: Chen
authors.affiliation: Laboratory for Epidemiology, Department of Health Care Management, and Health Aging Research Center, Chang Gung University, Taoyuan City, Taiwan; Department of Urology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Kuang-Hung
authors.initials: KH
authors.lastname: Hsu
authors.affiliation: School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan.
authors.forename: Hung-Yi
authors.initials: HY
authors.lastname: Chiou
authors.affiliation: School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan. Electronic address: mmwu@tmu.edu.tw.
authors.forename: Meei-Maan
authors.initials: MM
authors.lastname: Wu
authors.affiliation: Genomics Research Center, Academia Sinica, Taipei, Taiwan. Electronic address: chencj@gate.sinica.edu.tw.
authors.forename: Chien-Jen
authors.initials: CJ
authors.lastname: Chen
mesh_terms: D000368:Aged; D001152:Arsenicals / Q000032:analysis*; D004279:DNA, Viral / Q000097:blood; D060766:Drinking Water / Q000737:chemistry*; D005260:Female; D006514:Hepatitis B Surface Antigens / Q000097:blood; D019694:Hepatitis B, Chronic / Q000150:complications / Q000453:epidemiology*; D018937:Hepatitis C Antibodies / Q000097:blood; D019698:Hepatitis C, Chronic / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D008103:Liver Cirrhosis / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D013624:Taiwan / Q000453:epidemiology
chemical_list: D001152:Arsenicals; D004279:DNA, Viral; D060766:Drinking Water; D006514:Hepatitis B Surface Antigens; D018937:Hepatitis C Antibodies
keywords: Carcinogen; Contamination; Environmental Factors; Pollution