DECREMENTS IN LUNG FUNCTION ARE RELATED TO ARSENIC IN DRINKING WATER IN WEST BENGAL, INDIA

Abstract

ISEE-544 Introduction: Inorganic arsenic in drinking water has been associated with lung cancer mortality in South America and Asia. Some evidence suggests that ingested arsenic may also increase the risk for non-malignant respiratory diseases, such as COPD, but no study to date has systematically investigated respiratory effects on a population basis. The aim of this investigation was to study respiratory function, symptoms and disorders in a moderately exposed adult population in India. Methods: A cross-sectional study has been conducted in 1998/99 among subjects with and without arsenic related skin lesions of keratoses or hyperpigmentation in West Bengal, India. The study was based on survey participants, living in 21 villages, whose primary drinking water sources contained less than 500 microgram/L of inorganic arsenic in 1995/1996. Detailed arsenic lifetime exposure histories were assessed, and arsenic concentration was measured in water of tubewells subjects used as drinking water sources. Lung function was measured with a portable spirometer. Lifetime smoking and residential history, as well as socio-demographic variables were recorded. Participants further underwent a full medical examination, including a careful examination of the skin for arsenic-caused skin lesions. Lung function was analyzed in multiple linear regression models in relation to skin lesion status and peak arsenic water concentrations. Stratified analyses were carried out according to gender and smoking status. Results: Pronounced decrements in lung function were related to presence (vs. absence) of arsenic induced skin lesions in both non-smoking and smoking men, adjusted for age and height. Among non-smoking men, those with skin lesions had FEV1 measurements on average 226 ml lower than those without skin lesions (95% CI 10-442, p=0.04), and among smoking men, 168 ml lower (95% CI 0-335, p=0.05). Likewise, in non-smoking men, FVC was on average 247 ml lower (95% CI 20-475, p=0.03) in men with skin lesions compared to men without skin lesions, and in male smokers, 191 ml lower (95% CI 10-372, p=0.04). Increasing levels of peak arsenic in water were similarly related to decreases in pulmonary function in non-smoking and smoking men. In women, no such effects were observed. Discussion: These findings suggest marked effects of arsenic in drinking water on pulmonary function in men, with effects in both smokers and non-smokers. We do not know why women appear to be less susceptible to respiratory function effects, although it is noteworthy that women are also much less susceptible than men to getting arsenic-caused skin lesions.