Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts 02115, USA.
Environ Health Perspect. 2012 Dec;120(12):1733-8. doi: 10.1289/ehp.1205381. Epub 2012 Oct 10.
Chronic exposure to arsenic is associated with skin lesions. However, it is not known whether reducing arsenic exposure will improve skin lesions.
We evaluated the association between reduced arsenic exposures and skin lesion recovery over time.
A follow-up study of 550 individuals was conducted in 2009-2011 on a baseline population of skin lesion cases (n = 900) previously enrolled in Bangladesh in 2001-2003. Arsenic in drinking water and toenails, and skin lesion status and severity were ascertained at baseline and follow-up. We used logistic regression and generalized estimating equation (GEE) models to evaluate the association between log10-transformed arsenic exposure and skin lesion persistence and severity.
During the study period, water arsenic concentrations decreased in this population by 41% overall, and 65 individuals who had skin lesions at baseline had no identifiable lesions at follow-up. In the adjusted models, every log10 decrease in water arsenic and toenail arsenic was associated with 22% [odds ratio (OR) = 1.22; 95% CI: 0.85, 1.78] and 4.5 times (OR = 4.49; 95% CI: 1.94, 11.1) relative increase in skin lesion recovery, respectively. In addition, lower baseline arsenic levels were significantly associated with increased odds of recovery. A log10 decrease in toenail arsenic from baseline to follow-up was also significantly associated with reduced skin lesion severity in cases over time (mean score change of -5.22 units; 95% CI: -8.61, -1.82).
Reducing arsenic exposure increased the odds that an individual with skin lesions would recover or show less severe lesions within 10 years. Reducing arsenic exposure must remain a public health priority in Bangladesh and in other regions affected by arsenic-contaminated water.
慢性砷暴露与皮肤损伤有关。然而，目前尚不清楚减少砷暴露是否会改善皮肤损伤。
我们评估了随着时间的推移，减少砷暴露与皮肤损伤恢复之间的关系。
对 2001-2003 年孟加拉国基线人群（900 例皮肤损伤病例）中的 550 例个体进行了随访研究。在基线和随访时，确定了饮用水和脚趾甲中的砷含量以及皮肤损伤状况和严重程度。我们使用逻辑回归和广义估计方程（GEE）模型来评估经对数转换的砷暴露与皮肤损伤持续存在和严重程度之间的关系。
在研究期间，该人群的水中砷浓度总体下降了 41%，基线时有皮肤损伤的 65 人在随访时已无明显损伤。在调整后的模型中，水中砷和脚趾甲砷的每对数下降 10 个单位与皮肤损伤恢复的相对增加分别相关 22%[比值比（OR）=1.22；95%可信区间（CI）：0.85，1.78]和 4.5 倍（OR=4.49；95%CI：1.94，11.1）。此外，基线砷水平较低与恢复的可能性增加显著相关。从基线到随访时，脚趾甲砷的对数下降与病例中皮肤损伤严重程度的降低也显著相关（平均评分变化-5.22 单位；95%CI：-8.61，-1.82）。
减少砷暴露增加了患有皮肤损伤的个体在 10 年内恢复或显示较轻损伤的可能性。减少砷暴露必须仍然是孟加拉国和其他受砷污染水影响地区的公共卫生重点。
