Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA.
Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA.
Environ Res. 2021 May;196:110384. doi: 10.1016/j.envres.2020.110384. Epub 2020 Oct 28.
Between 1968 and 1983, public drinking water supplies of Cape Cod, Massachusetts were contaminated with the chlorinated solvent tetrachloroethylene (PCE). We previously found an affinity for risk-taking behaviors, including the use of illicit drugs, following prenatal and early childhood exposure to PCE. Using newly collected data, we investigated the risk of non-medical use of prescription drugs (NMUPD) following prenatal and early childhood PCE exposure.
Participants were identified from a retrospective cohort study ("Cape Cod Health Study") via cross-matching birth certificates and water system data. The original self-administered questionnaire gathered data on demographics, work and medical history, and alcohol and illicit drug use from 618 individuals (363 exposed and 255 unexposed). The follow-up survey added questions on non-medical use of prescription pain relievers, tranquilizers, stimulants and sedatives. A validated leaching and transport model was used to estimate exposure to PCE exposure in drinking water.
There was a wide distribution of cumulative prenatal and early childhood PCE exposure levels (range: 0.04 g-3722.2 g). PCE exposed subjects had a 1.92-fold increase in risk of any non-medical use of prescription drugs [Adjusted RR: 1.92, (95% CI: 1.31, 2.83)]. Furthermore, the association followed a dose-response relationship where the risk of NMUPD was higher for those exposed to PCE levels greater than or equal the median level versus those exposed to levels less than the median [Adjusted RR: 2.05 (95% CI: 1.34, 3.15) vs. 1.83 (95% CI: 1.20, 2.79) (p-value for trend < 0.01)]. Additionally, we found moderate increases in risk by level of non-medical use (any non-medical use, non-medical use of 1 or more categories of prescription drugs, or 2+ categories) as well as by category of drug for pain relivers, stimulants and tranquilizers.
We found that prenatal and early childhood exposure to PCE was associated with a moderate increase in the risk of NMUPD. Exposed subjects had dose-related increased risks of NMUPD of pain relievers, tranquilizers, and stimulants. This study has a number of limitations and is the first to report this association. Additional longitudinal studies of populations exposed to PCE during early life should be conducted to examine its long-term neurotoxic effects.
1968 年至 1983 年间，马萨诸塞州鳕鱼角的公共饮用水供应受到了四氯乙烯（PCE）的污染。我们之前发现，产前和幼儿期接触 PCE 会导致冒险行为的倾向增加，包括使用非法药物。利用新收集的数据，我们调查了产前和幼儿期 PCE 暴露后非医疗用途处方药物（NMUPD）的风险。
通过交叉匹配出生证明和水系统数据，从回顾性队列研究（“鳕鱼角健康研究”）中确定参与者。原始的自我管理问卷从 618 个人（363 名暴露组和 255 名未暴露组）收集了人口统计学、工作和医疗史以及酒精和非法药物使用的数据。后续调查增加了关于非医疗使用处方止痛药、镇静剂、兴奋剂和镇静剂的问题。使用经过验证的浸出和传输模型来估计饮用水中 PCE 的暴露水平。
产前和幼儿期 PCE 暴露水平的分布范围很广（范围：0.04g-3722.2g）。暴露于 PCE 的受试者 NMUPD 的风险增加了 1.92 倍[调整后的 RR：1.92（95%CI：1.31，2.83）]。此外，这种关联遵循剂量反应关系，即与暴露于 PCE 水平低于中位数的受试者相比，暴露于 PCE 水平大于或等于中位数的受试者 NMUPD 的风险更高[调整后的 RR：2.05（95%CI：1.34，3.15）vs.1.83（95%CI：1.20，2.79）（p 值趋势<0.01）]。此外，我们发现非医疗使用水平（任何非医疗使用、非医疗使用 1 种或多种类别的处方药物或 2 种或更多类别的药物）以及止痛药、兴奋剂和镇静剂类药物的风险呈中度增加。
我们发现，产前和幼儿期接触 PCE 与 NMUPD 的风险中度增加有关。暴露于 PCE 的受试者具有与剂量相关的 NMUPD 止痛药、镇静剂和兴奋剂风险增加。本研究存在一些局限性，是第一个报告这种关联的研究。应该对在生命早期接触 PCE 的人群进行更多的纵向研究，以检查其长期神经毒性作用。
