Effects of Arsenic in Drinking Water on Risk of Hepatitis or Cirrhosis in Persons With and Without Chronic Viral Hepatitis

Ling I. Hsu, Yuan Hung Wang, Fang I. Hsieh, Tse Yen Yang, Rachel Wen-Juei Jeng, Chien Ting Liu, Chi Ling Chen, Kuang Hung Hsu, Hung Yi Chiou, Meei-Maan Wu, Chien Jen Chen

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Abstract

Background & Aims: Arsenic in drinking water is associated with hepatomegaly and death from liver cancer. However, confounding factors related to liver diseases have not been carefully studied. We examined associations between exposure of arsenic in drinking water and risk of hepatitis and cirrhosis, and the interaction with chronic viral hepatitis, in people living in the Lanyang Basin of northeastern Taiwan, where well water has an arsenic content that ranges from undetectable to 3590 μg/L. Methods: We tested blood samples from 4387 people who lived in arseniasis-endemic areas in northeastern Taiwan from 1991 through 1994 for hepatitis B virus DNA, hepatitis B surface antigen (HBsAg), and antibodies against hepatitis C virus (anti-HCV). We measured arsenic concentrations in well water and collected information on residents' histories of major chronic diseases. Reports of chronic hepatitis or cirrhosis were ascertained using the Taiwan National Health Insurance database. Reports of liver cancer were ascertained using the Taiwan National Cancer Registry. Results: Prevalence odds ratios in the overall study population for chronic hepatitis or cirrhosis for well water arsenic concentrations of ≤10 μg/L were 1.00 (reference), 0.93 for 10.1-49.9 μg/L (95% confidence interval [CI], 0.57-1.52), 1.24 for 50.0-99.9 μg/L (95% CI, 0.68-2.23), 0.98 for 100.0-299.9 (95% CI, 0.52-1.85), and 1.86 for ≥300.0 μg/L (95% CI, 1.08-3.20). Increasing levels of arsenic in drinking water were associated with increasing prevalence of chronic hepatitis or cirrhosis in residents who were seronegative for HBsAg and seronegative for anti-HCV, but not for seropositive for either HBsAg or anti-HCV. In individuals who were seropositive for HBsAg or anti-HCV, we observed an inverse association between hepatitis or cirrhosis and consumption of water with levels of arsenic ≥100.0 μg/L. Among participants who were seropositive for HBsAg or anti-HCV, consumption of water with levels of arsenic ≥100.0 μg/L was associated with a reduced risk of liver cancer (multivariate-adjusted hazard ratio, 0.29; 95% CI, 0.09-0.95; . P <.05). A higher proportion of individuals exposed to cumulative arsenic level >14,000 μg/L ×year were carriers of inactive hepatitis B virus (DNA

Original languageEnglish
JournalClinical Gastroenterology and Hepatology
DOIs
Publication statusAccepted/In press - 2016

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Arsenic
Chronic Hepatitis
Drinking Water
Hepatitis
Fibrosis
Hepatitis B Antibodies
Hepatitis B Surface Antigens
Taiwan
Hepacivirus
Confidence Intervals
Liver Neoplasms
Hepatitis B virus
Drinking
Water
Hepatitis C Antibodies
Hepatomegaly
DNA
National Health Programs
Registries
Liver Diseases

Keywords

  • Carcinogen
  • Contamination
  • Environmental Factors
  • Pollution

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

Cite this

Effects of Arsenic in Drinking Water on Risk of Hepatitis or Cirrhosis in Persons With and Without Chronic Viral Hepatitis. / Hsu, Ling I.; Wang, Yuan Hung; Hsieh, Fang I.; Yang, Tse Yen; Wen-Juei Jeng, Rachel; Liu, Chien Ting; Chen, Chi Ling; Hsu, Kuang Hung; Chiou, Hung Yi; Wu, Meei-Maan; Chen, Chien Jen.

In: Clinical Gastroenterology and Hepatology, 2016.

Research output: Contribution to journalArticle

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abstract = "Background & Aims: Arsenic in drinking water is associated with hepatomegaly and death from liver cancer. However, confounding factors related to liver diseases have not been carefully studied. We examined associations between exposure of arsenic in drinking water and risk of hepatitis and cirrhosis, and the interaction with chronic viral hepatitis, in people living in the Lanyang Basin of northeastern Taiwan, where well water has an arsenic content that ranges from undetectable to 3590 μg/L. Methods: We tested blood samples from 4387 people who lived in arseniasis-endemic areas in northeastern Taiwan from 1991 through 1994 for hepatitis B virus DNA, hepatitis B surface antigen (HBsAg), and antibodies against hepatitis C virus (anti-HCV). We measured arsenic concentrations in well water and collected information on residents' histories of major chronic diseases. Reports of chronic hepatitis or cirrhosis were ascertained using the Taiwan National Health Insurance database. Reports of liver cancer were ascertained using the Taiwan National Cancer Registry. Results: Prevalence odds ratios in the overall study population for chronic hepatitis or cirrhosis for well water arsenic concentrations of ≤10 μg/L were 1.00 (reference), 0.93 for 10.1-49.9 μg/L (95{\%} confidence interval [CI], 0.57-1.52), 1.24 for 50.0-99.9 μg/L (95{\%} CI, 0.68-2.23), 0.98 for 100.0-299.9 (95{\%} CI, 0.52-1.85), and 1.86 for ≥300.0 μg/L (95{\%} CI, 1.08-3.20). Increasing levels of arsenic in drinking water were associated with increasing prevalence of chronic hepatitis or cirrhosis in residents who were seronegative for HBsAg and seronegative for anti-HCV, but not for seropositive for either HBsAg or anti-HCV. In individuals who were seropositive for HBsAg or anti-HCV, we observed an inverse association between hepatitis or cirrhosis and consumption of water with levels of arsenic ≥100.0 μg/L. Among participants who were seropositive for HBsAg or anti-HCV, consumption of water with levels of arsenic ≥100.0 μg/L was associated with a reduced risk of liver cancer (multivariate-adjusted hazard ratio, 0.29; 95{\%} CI, 0.09-0.95; . P <.05). A higher proportion of individuals exposed to cumulative arsenic level >14,000 μg/L ×year were carriers of inactive hepatitis B virus (DNA",
keywords = "Carcinogen, Contamination, Environmental Factors, Pollution, Carcinogen, Contamination, Environmental Factors",
author = "Hsu, {Ling I.} and Wang, {Yuan Hung} and Hsieh, {Fang I.} and Yang, {Tse Yen} and {Wen-Juei Jeng}, Rachel and Liu, {Chien Ting} and Chen, {Chi Ling} and Hsu, {Kuang Hung} and Chiou, {Hung Yi} and Meei-Maan Wu and Chen, {Chien Jen}",
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AU - Hsu, Ling I.

AU - Wang, Yuan Hung

AU - Hsieh, Fang I.

AU - Yang, Tse Yen

AU - Wen-Juei Jeng, Rachel

AU - Liu, Chien Ting

AU - Chen, Chi Ling

AU - Hsu, Kuang Hung

AU - Chiou, Hung Yi

AU - Wu, Meei-Maan

AU - Chen, Chien Jen

PY - 2016

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AB - Background & Aims: Arsenic in drinking water is associated with hepatomegaly and death from liver cancer. However, confounding factors related to liver diseases have not been carefully studied. We examined associations between exposure of arsenic in drinking water and risk of hepatitis and cirrhosis, and the interaction with chronic viral hepatitis, in people living in the Lanyang Basin of northeastern Taiwan, where well water has an arsenic content that ranges from undetectable to 3590 μg/L. Methods: We tested blood samples from 4387 people who lived in arseniasis-endemic areas in northeastern Taiwan from 1991 through 1994 for hepatitis B virus DNA, hepatitis B surface antigen (HBsAg), and antibodies against hepatitis C virus (anti-HCV). We measured arsenic concentrations in well water and collected information on residents' histories of major chronic diseases. Reports of chronic hepatitis or cirrhosis were ascertained using the Taiwan National Health Insurance database. Reports of liver cancer were ascertained using the Taiwan National Cancer Registry. Results: Prevalence odds ratios in the overall study population for chronic hepatitis or cirrhosis for well water arsenic concentrations of ≤10 μg/L were 1.00 (reference), 0.93 for 10.1-49.9 μg/L (95% confidence interval [CI], 0.57-1.52), 1.24 for 50.0-99.9 μg/L (95% CI, 0.68-2.23), 0.98 for 100.0-299.9 (95% CI, 0.52-1.85), and 1.86 for ≥300.0 μg/L (95% CI, 1.08-3.20). Increasing levels of arsenic in drinking water were associated with increasing prevalence of chronic hepatitis or cirrhosis in residents who were seronegative for HBsAg and seronegative for anti-HCV, but not for seropositive for either HBsAg or anti-HCV. In individuals who were seropositive for HBsAg or anti-HCV, we observed an inverse association between hepatitis or cirrhosis and consumption of water with levels of arsenic ≥100.0 μg/L. Among participants who were seropositive for HBsAg or anti-HCV, consumption of water with levels of arsenic ≥100.0 μg/L was associated with a reduced risk of liver cancer (multivariate-adjusted hazard ratio, 0.29; 95% CI, 0.09-0.95; . P <.05). A higher proportion of individuals exposed to cumulative arsenic level >14,000 μg/L ×year were carriers of inactive hepatitis B virus (DNA

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KW - Contamination

KW - Environmental Factors

KW - Pollution

KW - Carcinogen

KW - Contamination

KW - Environmental Factors

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