Abstract
The present study aimed to investigate the association between bone diseases and community water fluoridation (CWF). An ecological study with a natural experiment design was conducted in Cheongju, South Korea, from 1 January 2004 to 31 December 2013. The community water fluoridation program was implemented in Cheongju and divided into CWF and non-CWF areas. To observe adverse health effects related to bone diseases, we conducted a spatio-temporal analysis of the prevalence of hip fracture, osteoporosis, and bone cancer in residents who have lived in CWF and non-CWF areas using National Health Insurance Service data. First, we used standardized incidence ratios to estimate the disease risk. Second, the hierarchical Bayesian Poisson spatio-temporal regression model was used to investigate the association between the selected bone diseases and CWF considering space and time interaction. The method for Bayesian estimation was based on the R-integrated nested Laplace approximation (INLA). Comparing the CWF area with the non-CWF area, there was no clear evidence that exposure to CWF increased health risks at the town level in Cheongju since CWF was terminated after 2004. The posterior relative risks (RR) of hip fracture was 0.95 (95% confidence intervals 0.87, 1.05) and osteoporosis was 0.94 (0.87, 1.02). The RR in bone cancer was a little high because the sample size very small compared to the other bone diseases (RR = 1.20 (0.89, 1.61)). The relative risk of selected bone diseases (hip fractures, osteoporosis, and bone cancer) increased over time but did not increase in the CWF area compared to non-CWF areas. CWF has been used to reduce dental caries in all population groups and is known for its cost-effectiveness. These findings suggest that CWF is not associated with adverse health risks related to bone diseases. This study provides scientific evidence based on a natural experiment design. It is necessary to continue research on the well-designed epidemiological studies and develop public health prevention programs to help in make suitable polices.
Highlights
Community water fluoridation (CWF) aims to prevent dental caries by adjusting the amount of fluoride in tap water to ensure that it is fit for human consumption [1]
CWF has been used to reduce dental caries in all population groups and is known for its cost-effectiveness. These findings suggest that CWF is not associated with adverse health risks related to bone diseases
We investigated the effect of drinking tap water by comparing hip fractures, osteoporosis, and bone cancer prevalence in Cheongju, South Korea, where the area was naturally divided depending on the implementation status of drinking fluoridated water
Summary
Community water fluoridation (CWF) aims to prevent dental caries by adjusting the amount of fluoride in tap water to ensure that it is fit for human consumption [1]. Considering the fact that care for oral health presents a significant burden to national health, CWF is the most economical and effective public health care method to prevent tooth decay even among adults [2,3]. Health authorities, including many researchers, have argued that if CWF is meant to benefit the large population, it is necessary to assess all the risks associated with it. Many epidemiological studies are needed to assess its risk, yet only a few people consume fluoridated water for a long time because. Res. Public Health 2020, 17, 9170; doi:10.3390/ijerph17249170 www.mdpi.com/journal/ijerph
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