Division of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, IL, USA.
Department of Groundwater and Quaternary Geology Mapping, Geological Survey of Denmark and Greenland, Aarhus, Denmark; Department of Public Health, Aarhus University, Aarhus, Denmark.
Environ Int. 2021 Oct;155:106613. doi: 10.1016/j.envint.2021.106613. Epub 2021 May 6.
There is limited evidence that nitrate, a common contaminant in drinking water, increases the risk of childhood cancers. Our objective was to examine this association in Denmark.
We conducted a nationwide case-control study based on all singletons liveborn to Danish-born parents from 1991 to 2015 (N = 1,219,140) that included 596 leukemias, 180 lymphomas, and 310 central nervous system cancers (CNC) who were ≤15 years of age at diagnosis and were identified from the Danish Cancer Registry. Approximately 100 controls were randomly selected and matched to each case on date of birth and sex. Nitrate measurements in public water systems were linked with an address registry to estimate individual average nitrate concentrations during preconception, prenatal, and postnatal periods. Odd ratios (OR) and 95% confidence intervals (95%CI) were estimated using conditional logistic regression controlling for the matching variables, and birth order, birthweight, urbanicity, maternal education, employment, income and smoking, and parental age.
There was no evidence of an association of nitrate with leukemia or lymphoma. An association between CNC and the highest category of nitrate exposure (>25 mg/L nitrate) was observed for preconception (OR = 1.82, 95%CI:1.09 to 3.04), prenatal (OR = 1.65, 95%CI:0.97 to 2.81), and postnatal exposure (OR = 1.48, 95%CI:0.82 to 2.68) in fully adjusted models. There was also some evidence of an exposure-response in models of continuous nitrate exposure and CNC.
Our findings provide some evidence that exposure to nitrate from drinking water may increase the risk of childhood CNC cancer, but not leukemia or lymphoma.
有有限的证据表明，硝酸盐是饮用水中的一种常见污染物，会增加儿童癌症的风险。我们的目的是在丹麦研究这种关联。
我们进行了一项基于丹麦出生父母于 1991 年至 2015 年期间所生的所有单胎（N=1,219,140）的全国性病例对照研究，其中包括 596 例白血病、180 例淋巴瘤和 310 例中枢神经系统癌症（CNS），这些患者在诊断时年龄均≤15 岁，且均来自丹麦癌症登记处。每个病例随机选择了大约 100 个对照，并按出生日期和性别与病例相匹配。将公共供水系统中的硝酸盐测量值与地址登记册相链接，以估算每个个体在受孕前、孕期和产后期间的平均硝酸盐浓度。使用条件逻辑回归控制匹配变量、出生顺序、出生体重、城市化程度、母亲教育程度、就业、收入和吸烟以及父母年龄，估计比值比（OR）和 95%置信区间（95%CI）。
硝酸盐与白血病或淋巴瘤均无关联。在完全调整的模型中，CNS 与受孕前（OR=1.82，95%CI：1.09 至 3.04）、孕期（OR=1.65，95%CI：0.97 至 2.81）和产后暴露（OR=1.48，95%CI：0.82 至 2.68）的最高硝酸盐暴露类别（>25mg/L 硝酸盐）之间存在关联。在连续硝酸盐暴露和 CNS 的模型中也有一些暴露-反应的证据。
我们的研究结果提供了一些证据，表明饮用水中硝酸盐的暴露可能会增加儿童 CNS 癌症的风险，但不会增加白血病或淋巴瘤的风险。
