Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan.
J Toxicol Environ Health A. 2012;75(6):340-50. doi: 10.1080/15287394.2012.668162.
The objectives of this study were to (1) examine the relationship between total trihalomethanes (TTHM) levels in public water supplies and risk of development of kidney cancer and (2) determine whether hardness levels in drinking water modify the effects of TTHM on risk of kidney cancer induction. A matched case-control study was used to investigate the relationship between the risk of death attributed to kidney cancer and exposure to TTHM in drinking water in 53 municipalities in Taiwan. All kidney cancer deaths in the 53 municipalities from 1998 through 2007 were obtained. Controls were deaths from other causes and were pair-matched to the cancer cases by gender, year of birth, and year of death. Each matched control was selected randomly from the set of possible controls for each cancer case. Data on TTHM levels and levels of hardness in drinking water were also collected. The municipality of residence for cancer cases and controls was presumed to be the source of the subject's TTHM and hardness exposure via drinking water. Relative to individuals whose TTHM exposure level was <4.9 ppb, the adjusted OR (95% CI) for kidney cancer was 0.98 (0.77-1.25) for individuals who resided in municipalities served by drinking water with a TTHM exposure ≥4.9 ppb. However, evidence of an interaction was noted between the use of soft water and drinking water TTHM concentrations. Increased knowledge of the interaction between hardness and TTHM levels in reducing risk of kidney cancer development will aid in public policy decision and establishing standards to prevent disease occurrence.
(1) 检验公共供水系统中总三卤甲烷 (TTHM) 水平与肾癌发展风险之间的关系；(2) 确定饮用水硬度是否会改变 TTHM 对肾癌诱导风险的影响。采用病例对照研究方法，调查了台湾 53 个市供水中 TTHM 暴露与归因于肾癌的死亡风险之间的关系。获得了 1998 年至 2007 年期间台湾 53 个市所有归因于肾癌的死亡病例。对照组为其他原因死亡，并按性别、出生年份和死亡年份与癌症病例进行配对。每个匹配的对照均随机从每个癌症病例的可能对照中选择。还收集了 TTHM 水平和饮用水硬度水平的数据。将癌症病例和对照的居住市确定为通过饮用水接触 TTHM 和硬度的来源。与 TTHM 暴露水平<4.9 ppb 的个体相比，TTHM 暴露水平≥4.9 ppb 的市供水的个体，肾癌的调整 OR（95%CI）为 0.98（0.77-1.25）。然而，注意到软水使用与饮用水 TTHM 浓度之间存在交互作用的证据。增加对硬度与 TTHM 水平之间相互作用降低肾癌发展风险的认识，将有助于公共政策决策和制定预防疾病发生的标准。
