Regional drinking water composition effects on hip fracture risk: a spatial analysis of nationwide hospital admissions in Portugal, from 2000 to 2010

Carla Maria Oliveira,Sandra Maria Alves,Hugo Teixeira,Maria Fátima Pina

doi:10.1590/s0104-12902020200094

Abstract

Abstract Geographical variation on hip fractures (HF) may be related to the geographical variation of drinking water composition (DWC); minerals in drinking water may contribute to its fragility. We aim to investigate the effects of DWC on HF risk in Portugal (2000-2010). From National Hospital Discharge Register we selected admissions of patients aged ≥50 years, diagnosed with HF caused by low/moderate energy traumas. Water components and characteristics were selected at the municipality level. A spatial generalized additive model with a negative binomial distribution as a link function was used to estimate the association of HF with variations in DWC. There were 96,905HF (77.3% in women). The spatial pattern of HF risk was attenuated after being adjusted for water parameters. Results show an indirect association between calcium, magnesium, and iron and HF risk but no clear relation between aluminum, cadmium, fluoride, manganese, or color and HF risk. Regarding pH, the 6.7pH and 7pH interval seems to pose a lower risk. Different dose-response relationships were identified. The increase of calcium, magnesium, and iron values in DWC seems to reduce regional HF risk. Long-term exposure to water parameters, even within the regulatory limits, might increase the regional HF risk.

Highlights

A variabilidade espacial existente na fratura do colo do fêmur (FCF) pode estar relacionada com a variabilidade geográfica da composição da água para consumo (CAC), devido à ação dos minerais na fragilidade óssea
There is a spatial effect on hip fractures (HF) risk and we observed changes between model 1 and model 2: the relative risk (RR) is lower in model 2 than in model 1, suggesting that drinking water composition might interfere in the spatial distribution of HF risk (Figure 3)
We found spatial differences in the HF risk after including drinking water composition (DWC) in the model, suggesting that municipality DWC might influence HF risk

Summary

Introduction

A variabilidade espacial existente na fratura do colo do fêmur (FCF) pode estar relacionada com a variabilidade geográfica da composição da água para consumo (CAC), devido à ação dos minerais na fragilidade óssea. Do registo nacional de altas hospitalares, foram selecionadas todas as admissões em indivíduos ≥50, com diagnóstico de FCF causado por trauma de baixo/moderado impacto. Um modelo espacial aditivo generalizado, com a distribuição binomial negativa como função de ligação, foi usado para estimar a associação de FCF e as variações da CAC. O padrão espacial de risco de FCF foi atenuado após ser ajustado pelos parâmetros da CAC. O aumento do cálcio, magnésio e ferro na CAC parece reduzir o risco regional de FCF. Uma exposição a longo prazo, mesmo obedecendo aos limites impostos por lei, parece aumentar o risco regional de FCF. Palavras-chave: Fractura do Colo do Fêmur; Composição de Água Potável; Admissões Hospitalares; Epidemiologia Espacial

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