Category Archives: exposure

Meta-analyses are very squishy when something is made up out of nothing

S. Stanley Young and Warren B. Kindzierski. Evaluation of a meta-analysis of air quality and heart attacks, a case studyCritical Reviews in Toxicology

It is generally acknowledged that claims from observational studies often fail to replicate. An exploratory study was undertaken to assess the reliability of base studies used in meta-analysis of short-term air quality-myocardial infarction risk and to judge the reliability of statistical evidence from meta-analysis that uses data from observational studies. A highly cited meta-analysis paper examining whether short-term air quality exposure triggers myocardial infarction was evaluated as a case study. The paper considered six air quality components – carbon monoxide, nitrogen dioxide, sulphur dioxide, particulate matter 10 lm and 2.5 lm in diameter (PM10 and PM2.5), and ozone. The number of possible questions and statistical models at issue in each of 34 base papers used were estimated and p-value plots for each of the air components were constructed to evaluate the effect heterogeneity of p-values used from the base papers. Analysis search spaces (number of statistical tests possible) in the base papers were large, median 1⁄4 12,288 (interquartile range 1⁄4 2496 ” 58,368), in comparison to actual statistical test results presented. Statistical test results taken from the base papers may not provide unbiased measures of effect for meta-analysis. Shapes of p-value plots for the six air components were consistent with the possibility of analysis manipulation to obtain small p-values in several base papers. Results suggest the appearance of heterogeneous, researcher-generated p-values used in the meta-analysis rather than unbiased evidence of real effects for air quality. We conclude that this meta-analysis does not provide reliable evidence for an association of air quality components with myocardial risk.

Brewed tea a significant source of trihalomethane exposure

Fakour H, Lo SL. Formation and risk assessment of trihalomethanes through different tea brewing habits. Int J Hyg Environ Health. 2018 Sep 1. pii: S1438-4639(18)30193-7. doi: 10.1016/j.ijheh.2018.08.013.

Trihalomethanes (THMs) are suspected carcinogens and reproductive toxicants commonly found in chlorinated drinking water. This study investigates the formation of THMs and their associated risks during different tea brewing habits. Three main categories of tea (black, oolong, and green) under various brewing conditions and drinking water sources were tested. Tea samples prepared in ordinary thermos flask formed significant levels of total THM (TTHM). The highest TTHM formation came from black tea made with tap water, plausibly due to higher concentrations of reactive THM precursors. Compared with tap water, when the background solution is bottled water or distilled water, less TTHM was observed in prepared tea infusions. The results also revealed that unlike the traditional teapot-based tea serving habit, the removal of THMs is significantly reduced when tea infusion is stored in enclosed containers. Risk assessment analysis based on the survey among tea shop costumers also revealed that cancer risks induced by ingestion of THMs through drinking tea infusions prepared in thermos flask exceeded the tolerable level. Data obtained in this research demonstrated that drinking tea infusions directly from enclosed containers can be a significant source of exposure to THMs.

Exposure routes and health effects of microcystins

Massey IY, Yang F, Ding Z, Yang S, Guo J, Tezi C, Al-Osman M, Kamegni RB, Zeng W. Exposure Routes and Health Effects of Microcystins on Animals and Humans: A Mini-review. Toxicon. 2018 Jul 9. pii: S0041-0101(18)30306-4. doi: 10.1016/j.toxicon.2018.07.010.

Microcystins (MCs) pollution has quickly risen in infamy and has become a major problem to public health worldwide. MCs are a group of monocyclic hepatotoxic peptides, which are produced by some bloom-forming cyanobacteria in water. More than 100 different MCs variants posing a great threat to animals and humans due to their potential carcinogenicity have been reported. To reduce MCs risks, the World Health Organization has set a provisional guideline of 1 µg/L MCs in human’s drinking water. This paper provides an overview of exposure routes of MCs into the human system and health effects on different organs after MCs exposure including the liver, intestine, brain, kidney, lung, heart and reproductive system. In addition, some evidences on human poisoning and deaths associated with MCs exposure are presented. Finally, in order to protect human life against the health threats posed by MCs, this paper also suggests some directions for future research that can advance MCs control and minimize human exposure to MCs.

Nationwide drinking water sampling for exposure assessment, Denmark

Voutchkova DD, Hansen B, Ernstsen V, Kristiansen SM.Nationwide Drinking Water Sampling Campaign for Exposure Assessments in Denmark. International journal of environmental research and public health. 2018 Mar 7;15(3). pii: E467. doi: 10.3390/ijerph15030467.

Nationwide sampling campaign of treated drinking water of groundwater origin was designed and implemented in Denmark in 2013. The main purpose of the sampling was to obtain data on the spatial variation of iodine concentration and speciation in treated drinking water, which was supplied to the majority of the Danish population. This data was to be used in future exposure and epidemiologic studies. The water supply sector (83 companies, owning 144 waterworks throughout Denmark) was involved actively in the planning and implementation process, which reduced significantly the cost and duration of data collection. The dataset resulting from this collaboration covers not only iodine species (I, IO₃, TI), but also major elements and parameters (pH, electrical conductivity, DOC, TC, TN, F, Cl, NO₃, SO₄2-, Ca²⁺, Mg²⁺, K⁺, Na⁺) and a long list of trace elements (n = 66). The water samples represent 144 waterworks abstracting about 45% of the annual Danish groundwater abstraction for drinking water purposes, which supply about 2.5 million Danes (45% of all Danish residents). This technical note presents the design, implementation, and limitations of such a sampling design in detail in order (1) to facilitate the future use of this dataset, (2) to inform future replication studies, or (3) to provide an example for other researchers.

Urinary Arsenic Levels Decline in US Population Served by Public Water Supplies

Nigra AE, Sanchez TR, Nachman KE, Harvey D, Chillrud SN, Graziano JH, Navas-Acien A. The effect of the Environmental Protection Agency maximum contaminant level on arsenic exposure in the USA from 2003 to 2014: an analysis of the National Health and Nutrition Examination Survey (NHANES). Lancet Public Health. 2017 Nov;2(11):e513-e521. doi: 10.1016/S2468-2667(17)30195-0.

BACKGROUND: The current US Environmental Protection Agency (EPA) maximum contaminant level (MCL) for arsenic in public water systems (10 µg/L) took effect in 2006. Arsenic is not federally regulated in private wells. The impact of the 2006 MCL on arsenic exposure in the US, as confirmed through biomarkers, is presently unknown. We evaluated national trends in water arsenic exposure in the US, hypothesizing that urinary arsenic levels would decrease over time among participants using public water systems but not among those using well water. We further estimated the expected number of avoided lung, bladder, and skin cancer cases.

METHODS: We evaluated 14,127 participants in the National Health and Nutrition Examination Survey (NHANES) 2003-2014 with urinary dimethylarsinate (DMA) and total arsenic available. To isolate water exposure, we expanded a residual-based method to remove tobacco and dietary contributions of arsenic. We applied EPA risk assessment approaches to estimate the expected annual number of avoided cancer cases comparing arsenic exposure in 2013-2014 vs. 2003-2004.

FINDINGS: Among public water users, fully adjusted geometric means (GMs) of DMA decreased from 3.01 µg/L in 2003-2004 to 2.49 µg/L in 2013-2014 (17% reduction; 95% confidence interval 10%, 24%; p-trend<0.01); no change was observed among well water users (p-trend= 0.35). Assuming these estimated exposure reductions will remain similar across a lifetime, we estimate a reduction of 200 to 900 lung and bladder cancer cases per year depending on the approach used.

INTERPRETATION: The decline in urinary arsenic among public water but not private well users in NHANES 2003-2014 indicates that the implementation of the current MCL has reduced arsenic exposure in the US population. Our study supports prior work showing that well water users are inadequately protected against drinking water arsenic, and confirms the critical role of federal drinking water regulations in reducing toxic exposures and protecting human health.

Tea Drinking a Substantial Source of Fluoride Exposure, Ireland

Waugh DT, Potter W, Limeback H, Godfrey M. Risk Assessment of Fluoride Intake from Tea in the Republic of Ireland and its Implications for Public Health and Water Fluoridation. International journal of environmental research and public health. 2016 Feb 26;13(3). pii: E259. doi: 10.3390/ijerph13030259.

The Republic of Ireland (RoI) is the only European Country with a mandatory national legislation requiring artificial fluoridation of drinking water and has the highest per capita consumption of black tea in the world. Tea is a hyperaccumulator of fluoride and chronic fluoride intake is associated with multiple negative health outcomes. In this study, fifty four brands of the commercially available black tea bag products were purchased and the fluoride level in tea infusions tested by an ion-selective electrode method. The fluoride content in all brands tested ranged from 1.6 to 6.1 mg/L, with a mean value of 3.3 mg/L. According to our risk assessment it is evident that the general population in the RoI is at a high risk of chronic fluoride exposure and associated adverse health effects based on established reference values. We conclude that the culture of habitual tea drinking in the RoI indicates that the total cumulative dietary fluoride intake in the general population could readily exceed the levels known to cause chronic fluoride intoxication. Evidence suggests that excessive fluoride intake may be contributing to a wide range of adverse health effects. Therefore from a public health perspective, it would seem prudent and sensible that risk reduction measures be implemented to reduce the total body burden of fluoride in the population.

Hazard Ranking Method for Arsenic Exposure from Private Wells, UK

Crabbe H, Fletcher T, Close R, Watts MJ, Ander EL, Smedley PL, Verlander NQ, Gregory M, Middleton DRS, Polya DA, Studden M, Leonardi GS. Hazard Ranking Method for Populations Exposed to Arsenic in Private Water Supplies: Relation to Bedrock Geology. Int J Environ Res Public Health. 2017 Dec 1;14(12). pii: E1490. doi: 10.3390/ijerph14121490.

Approximately one million people in the UK are served by private water supplies (PWS) where main municipal water supply system connection is not practical or where PWS is the preferred option. Chronic exposure to contaminants in PWS may have adverse effects on health. South West England is an area with elevated arsenic concentrations in groundwater and over 9000 domestic dwellings here are supplied by PWS. There remains uncertainty as to the extent of the population exposed to arsenic (As), and the factors predicting such exposure. We describe a hazard assessment model based on simplified geology with the potential to predict exposure to As in PWS. Households with a recorded PWS in Cornwall were recruited to take part in a water sampling programme from 2011 to 2013. Bedrock geologies were aggregated and classified into nine Simplified Bedrock Geological Categories (SBGC), plus a cross-cutting “mineralized” area. PWS were sampled by random selection within SBGCs and some 508 households volunteered for the study. Transformations of the data were explored to estimate the distribution of As concentrations for PWS by SBGC. Using the distribution per SBGC, we predict the proportion of dwellings that would be affected by high concentrations and rank the geologies according to hazard. Within most SBGCs, As concentrations were found to have log-normal distributions. Across these areas, the proportion of dwellings predicted to have drinking water over the prescribed concentration value (PCV) for As ranged from 0% to 20%. From these results, a pilot predictive model was developed calculating the proportion of PWS above the PCV for As and hazard ranking supports local decision making and prioritization. With further development and testing, this can help local authorities predict the number of dwellings that might fail the PCV for As, based on bedrock geology. The model presented here for Cornwall could be applied in areas with similar geologies. Application of the method requires independent validation and further groundwater-derived PWS sampling on other geological formations.