Big Data Center, China Medical University Hospital and China Medical University, Taichung, Taiwan; Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and China Medical University, Taichung, Taiwan; Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, NY, USA.
Environ Int. 2022 Jan 15;159:107029. doi: 10.1016/j.envint.2021.107029. Epub 2021 Dec 7.
The effect of low-moderate levels of arsenic exposure and of arsenic metabolism on mortality remains uncertain. We used data from a prospective cohort study in 3600 men and women aged 45 to 75 years living in Arizona, Oklahoma, and North and South Dakota. The biomarker of inorganic arsenic exposure was the sum of urine inorganic (iAs), monomethylated (MMA) and dimethylated (DMA) arsenic compounds (ƩAs) at baseline. The proportions of urine iAs, MMA and DMA over the ƩiAs, expressed as iAs%, MMA%, and DMA%, respectively, were used as biomarkers of arsenic metabolism. Arsenic exposure and arsenic metabolism were associated with all-cause, cardiovascular, and cancer mortality. For each interquartile range (IQR) increase in ƩAs (12.5 μg/L, overall range 0.7-194.1 μg/L), the adjusted hazard ratios (aHRs) were 1.28 (95% CI 1.16-1.41) for all-cause mortality, 1.28 (1.08-1.52) for cardiovascular mortality and 1.15 (0.92-1.44) for cancer mortality. The aHR for mortality for each IQR increase in MMA%, when iAs% is decreasing, was 1.52 (95% CI 1.16-1.99) for cardiovascular disease, 0.73 (0.55-0.98) for cancer, and 1.03 (0.90-1.19) for all-cause mortality. These findings at low-moderate levels of arsenic exposure highlight the need to implement public health measures to protect populations from involuntary arsenic exposure and for research to advance the biological and clinical understanding of arsenic-related health effects in general populations.
砷暴露水平处于低中度时，砷代谢对死亡率的影响仍不确定。我们使用了来自亚利桑那州、俄克拉荷马州、北达科他州和南达科他州 3600 名 45 至 75 岁男女的前瞻性队列研究的数据。无机砷暴露的生物标志物是基线时尿液中无机砷（iAs）、单甲基化（MMA）和二甲基化（DMA）砷化合物的总和（ƩAs）。尿液中 iAs、MMA 和 DMA 分别占ƩiAs 的比例，以 iAs%、MMA%和 DMA%表示，用作砷代谢的生物标志物。砷暴露和砷代谢与全因、心血管和癌症死亡率相关。对于ƩAs 每增加一个四分位距（IQR）（12.5μg/L，总范围 0.7-194.1μg/L），全因死亡率的校正后危险比（aHR）为 1.28（95%CI 1.16-1.41），心血管死亡率为 1.28（1.08-1.52），癌症死亡率为 1.15（0.92-1.44）。当 iAs% 降低时，MMA% 每增加一个 IQR，心血管疾病死亡率的 aHR 为 1.52（95%CI 1.16-1.99），癌症死亡率为 0.73（95%CI 0.55-0.98），全因死亡率为 1.03（95%CI 0.90-1.19）。这些在低中度砷暴露水平下的发现强调了需要实施公共卫生措施，以保护人群免受非自愿的砷暴露，并进行研究，以提高一般人群对与砷相关的健康影响的生物学和临床认识。
