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Arsenic and Lung Disease Mortality in Bangladeshi Adults

Argos, Mariaa; Parvez, Faruqueb; Rahman, Mahfuzarc; Rakibuz-Zaman, Muhammadc; Ahmed, Alauddinc; Hore, Samar Kumard; Islam, Tariqulc; Chen, Yue; Pierce, Brandon L.a; Slavkovich, Vesnab; Olopade, Christopherf; Yunus, Muhammadd; Baron, John A.g; Graziano, Joseph H.b; Ahsan, Habibula,h

doi: 10.1097/EDE.0000000000000106

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.

Author Information

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.

Submitted 9 May 2013; accepted 14 January 2014; posted 6 May 2014.

The authors report no conflicts of interest.

Supported by the National Institutes of Health (grant numbers P42 ES010349 and R01 CA107431).

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Correspondence: Habibul Ahsan, 5841 South Maryland Avenue, MC2007, University of Chicago, Chicago, IL 60637. E-mail:

© 2014 by Lippincott Williams & Wilkins, Inc