Division of Pulmonary and Critical Care Medicine, Dept of Medicine, Harlem Hospital, Columbia University, New York, NY 10037, USA.
Eur Respir J. 2012 May;39(5):1076-83. doi: 10.1183/09031936.00042611. Epub 2011 Nov 16.
Bangladesh has high well water arsenic exposure. Chronic arsenic ingestion may result in diseases that manifest as dyspnoea, although information is sparse. Baseline values were obtained from an arsenic study. Trained physicians ascertained data on dyspnoea among 11,746 subjects. Data were collected on demographic factors, including smoking, blood pressure and arsenic exposure. Logistic regression models estimated odds ratios and confidence intervals for the association between arsenic exposure and dyspnoea. The adjusted odds of having dyspnoea was 1.32-fold (95% CI 1.15-1.52) greater in those exposed to high well water arsenic concentrations (≥ 50 μg · L(-1)) compared with low-arsenic-exposed nonsmokers (p<0.01). A significant dose-response relationship was found for arsenic (as well as smoking) in relation to dyspnoea. In nonsmokers, the adjusted odds of having dyspnoea were 1.36, 1.96, 2.34 and 1.80-fold greater for arsenic concentrations of 7-38, 39-90, 91-178 and 179-864 μg · L(-1), respectively, compared with the reference arsenic concentration of <7 μg · L(-1) (p<0.01; Chi-squared test for trend). Arsenic exposure through well water is associated with dyspnoea, independently of smoking status. This study suggests that mandated well water testing for arsenic with reduction in exposure may significantly reduce diseases that manifest as dyspnoea, usually cardiac or pulmonary.
孟加拉国的井水砷暴露水平较高。长期摄入砷可能会导致呼吸困难等疾病,但相关信息较为匮乏。本研究的基线数据来自于砷暴露情况的研究。经培训的医生在 11746 名研究对象中确定了呼吸困难数据。收集了包括吸烟、血压和砷暴露情况在内的人口统计学因素的数据。使用逻辑回归模型评估了砷暴露与呼吸困难之间的关联的比值比和置信区间。与低砷暴露且不吸烟的人群相比,暴露于高浓度井水砷(≥50μg·L-1)的人群发生呼吸困难的调整后比值比(95%CI 1.15-1.52)高出 1.32 倍(p<0.01)。发现砷(以及吸烟)与呼吸困难之间存在显著的剂量-反应关系。在不吸烟者中,与参考砷浓度(<7μg·L-1)相比,砷浓度分别为 7-38、39-90、91-178 和 179-864μg·L-1 时,发生呼吸困难的调整后比值比分别高出 1.36、1.96、2.34 和 1.80 倍(p<0.01;趋势性卡方检验)。经井水摄入的砷暴露与呼吸困难独立相关,与吸烟状况无关。本研究表明,强制进行井水砷检测并降低砷暴露水平,可能会显著减少以呼吸困难为主要表现的疾病,通常是心脏或肺部疾病。