ArticlePloS one2015
Arsenic in Drinking Water and Mortality for Cancer and Chronic Diseases in Central Italy, 1990-2010.
Article in PloS one, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 53 papers, 9 of them syntheses that pooled it.
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Who cites it
53 citing papers in PubMed, 9 syntheses or guidelines pooled it, 113 citations in OpenAlex.
- Low-level exposure to arsenic in drinking water and risk of type 2 diabetes: a systematic review and meta-analysis.European journal of epidemiology · 2026Pooled it
- "Low-to-moderate arsenic exposure: a global systematic review of cardiovascular disease risks".Environmental health : a global access science source · 2025Pooled it
- Interaction between Occupational and Non-Occupational Arsenic Exposure and Tobacco Smoke on Lung Cancerogenesis: A Systematic Review.International journal of environmental research and public health · 2023Pooled it
- Environmental toxic metal contaminants and risk of stroke: a systematic review and meta-analysis.Environmental science and pollution research international · 2022Pooled it
- Urinary arsenic and heart disease mortality in NHANES 2003-2014.Environmental research · 2021Pooled it
- Use of study-specific MOE-like estimates to prioritize health effects from chemical exposure for analysis in human health assessments.Environment international · 2020Pooled it
- Positive Association of Cardiovascular Disease (CVD) with Chronic Exposure to Drinking Water Arsenic (As) at Concentrations below the WHO Provisional Guideline Value: A Systematic Review and Meta-Analysis.International journal of environmental research and public health · 2020Pooled it
- Environmental toxic metal contaminants and risk of cardiovascular disease: systematic review and meta-analysis.BMJ (Clinical research ed.) · 2018Pooled it
- A dose-response meta-analysis of chronic arsenic exposure and incident cardiovascular disease.International journal of epidemiology · 2017Pooled it
- Arsenic Exposure During Pregnancy: Impacts to Maternal and Offspring Cardiovascular Health.Medical research archives · 2026Article
- The Association of Inorganic Arsenic Exposure with Hypertension and High Blood Pressure Among African Caribbean Adults in Tobago.International journal of environmental research and public health · 2026Article
- Arsenic in Water and Food: Toxicity and Human Exposure.Foods (Basel, Switzerland) · 2025Review
- Invited Perspective: Is It Time to Revisit the Allowable Maximum Contaminant Limit for Arsenic in Public Drinking Water?Environmental health perspectives · 2024Article
- Benchmark dose modeling for epidemiological dose-response assessment using prospective cohort studies.Risk analysis : an official publication of the Society for Risk Analysis · 2024Article
- Update of the risk assessment of inorganic arsenic in food.EFSA journal. European Food Safety Authority · 2024Article
- High Proportion of Arsenic Detected in Bronchoalveolar Fluid among Newly Diagnosed Lung Cancer in Jakarta Indonesia.Asian Pacific journal of cancer prevention : APJCP · 2023Article
- The global burden of lung cancer: current status and future trends.Nature reviews. Clinical oncology · 2023Review
- Relations between personal exposure to elevated concentrations of arsenic in water and soil and blood arsenic levels amongst people living in rural areas in Limpopo, South Africa.Environmental science and pollution research international · 2023Article
- Smoking and passive smoking increases mortality through mediation effect of cadmium exposure in the United States.Scientific reports · 2023Article
- miRNAs and arsenic-induced carcinogenesis.Advances in pharmacology (San Diego, Calif.) · 2023Review
Corrections and comments
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundIn several volcanic areas of Italy, arsenic levels exceed European regulatory limits (10 μg/L in drinking water). There is still uncertainty about health risks from arsenic at low-medium doses (<100 μg/L).
objectivesA large population-based study using an administrative cohort of residents in the Viterbo province (Central Italy), chronically exposed to low-medium arsenic levels via drinking water, was investigated to evaluate the effects of a lifetime exposure to arsenic on mortality from cancers and chronic diseases.
methodsThe study population consisted of 165,609 residents of 17 municipalities, followed from 1990 until 2010. Average individual arsenic exposure at the first residence (AsI) was estimated through a space-time modeling approach using residential history and arsenic concentrations from water supply. A time-dependent Cumulative Arsenic dose Indicator (CAI) was calculated, accounting for daily water intake and exposure duration. Mortality Hazard Ratios (HR) were estimated by gender for different diseases using Cox proportional models, adjusting for individual and area-level confounders. A flexible non-parametric approach was used to investigate dose-response relationships.
resultsMean AsI exposure was 19.3 μg/L, and average exposure duration was 39.5 years. Associations of AsI and CAI indicators with several diseases were found, with greatest risks found for lung cancer in both sexes (HR = 2.61 males; HR = 2.09 females), myocardial infarction, peripheral arterial disease and COPD in males (HR = 2.94; HR = 2.44; HR = 2.54 respectively) and diabetes in females (HR = 2.56). For lung cancer and cardiovascular diseases dose-response relationship is modelled by piecewise linear functions revealing effects even for doses lower than 10 μg/L, and no threshold dose value was identified as safe for health.
conclusionsResults provide new evidence for risk assessment of low-medium concentrations of arsenic and contribute to the ongoing debate about the threshold-dose of effect, suggesting that even concentrations below 10 μg/L carry a mortality risk. Policy actions are urgently needed in areas exposed to arsenic like in the Viterbo province, to comply with current EU regulations.
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