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American Journal of Epidemiology Advance Access published online on April 19, 2006
American Journal of Epidemiology, doi:10.1093/aje/kwj154
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American Journal of Epidemiology Copyright © 2006 by the Johns Hopkins Bloomberg School of Public Health All rights reserved; printed in U.S.A.
Received November 22, 2005
Accepted January 10, 2006

ORIGINAL CONTRIBUTIONS

Arsenic Exposure from Drinking Water and Risk of Premalignant Skin Lesions in Bangladesh: Baseline Results from the Health Effects of Arsenic Longitudinal Study

Habibul Ahsan 1 *, Yu Chen 2, Faruque Parvez 3, Lydia Zablotska 2, Maria Argos 2, Iftikhar Hussain 4, Hassina Momotaj 4, Diane Levy 5, Zhongqi Cheng 6, Vesna Slavkovich 3, Alexander van Geen 6, Geoffrey R. Howe 2, and Joseph H. Graziano 3

1 Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY
2 Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
3 Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY
4 National Institute of Preventive and Social Medicine, Dhaka, Bangladesh
5 Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY
6 Lamont-Doherty Earth Observatory, Columbia University, New York, NY

* To whom correspondence should be addressed.
Habibul Ahsan, E-mail: habibul.ahsan{at}columbia.edu


  Abstract

Millions of persons around the world are exposed to low doses of arsenic through drinking water. However, estimates of health effects associated with low-dose arsenic exposure have been extrapolated from high-dose studies. In Bangladesh, many persons have been exposed to a wide range of doses of arsenic from drinking water over a significant period of time. The authors evaluated dose-response relations between arsenic exposure from drinking water and premalignant skin lesions by using baseline data on 11,746 participants recruited in 2000-2002 for the Health Effects of Arsenic Longitudinal Study in Araihazar, Bangladesh. Several measures of arsenic exposure were estimated for each participant based on well-water arsenic concentration and usage pattern of the wells and on urinary arsenic concentration. In different regression models, consistent dose-response effects were observed for all arsenic exposure measures. Compared with drinking water containing <8.1 µg/liter of arsenic, drinking water containing 8.1-40.0, 40.1-91.0, 91.1-175.0, and 175.1-864.0 µg/liter of arsenic was associated with adjusted prevalence odds ratios of skin lesions of 1.91 (95% confidence interval (CI): 1.26, 2.89), 3.03 (95% CI: 2.05, 4.50), 3.71 (95% CI: 2.53, 5.44), and 5.39 (95% CI: 3.69, 7.86), respectively. The effect seemed to be influenced by gender, age, and body mass index. These findings provide information that should be considered in future research and policy decisions.

Keywords: arsenic; Bangladesh; cross-sectional studies; environmental exposure; keratosis; melanosis; risk.
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