Water disinfection by-products and bladder cancer: is there a European specificity? A pooled and meta-analysis of European case–control studies

Occupational and Environmental Medicine - Tập 68 Số 5 - Trang 379-385 - 2011
Nathalie Costet1, Cristina M. Villanueva2,3,4, Jouni J. K. Jaakkola5, Manolis Kogevinas2,3,6,7, Kenneth P. Cantor8, Will D. King9, C. F. Lynch10, Mark Nieuwenhuijsen2,3,6, Sylvaine Cordier11
1GERHM INSERM U625, Batiment 13, Université de Rennes 1, Campus de Beaulieu, F-35042 Rennes, France
2Center for Research in Environmental Epidemiology, Barcelona, Spain
3Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
4Municipal Institute of Medical Research (Institut Municipal d'Investigació Mèdica-Hospital del Mar), Barcelona, Spain
5Center for Environmental and Respiratory Health Research, Institute of Health Sciences, University of Oulu, Oulu, Finland
6Municipal Institute of Medical Research, Barcelona, Spain
7National School of Public Health, Athens, Greece
8KP Cantor, Environmental LLC, Silver Spring, Maryland, USA
9Department of Community Health and Epidemiology, Queen's University, Kingston, Ontario, Canada
10Department of Epidemiology, The University of Iowa, Iowa City, Iowa, USA
11Institut National de la Santé et de la Recherche Médicale (INSERM), U625, University of Rennes I, IFR-140, Groupe d'Etude sur la Reproduction chez l'Homme et le Mammifère, Rennes, France

Tóm tắt

Several epidemiological studies suggested an association between the risk of bladder cancer and the exposure to trihalomethanes (THMs), the main disinfection by-products (DBPs) of chlorinated water. A previous pooled analysis of case-control studies from North America and Europe estimated a summarized dose-response relation. For policy guidance of drinking water disinfection in Europe and because major differences exist in water disinfection practices and DBPs occurrence between both continents, specific risk estimates for bladder cancer in relation to DBPs exposure for European populations were needed. We conducted a pooled and a two-stage random-effect meta-analyses of three European case-control studies from France, Finland, and Spain (5467 individuals: 2381 cases and 3086 controls). Individual exposure to THMs was calculated combining information on residential history, estimates of the average total THMs (TTHM) level in tap water at the successive residences and personal water consumption. A significant odds-ratio was observed for men exposed to an average residential TTHM level > 50 μg/l (OR=1.47 (1.05; 2.05)) when compared to men exposed to levels ≤ 5 μg/l. The linear trend of the exposure-risk association was significant (p=0.01). Risks increased significantly for exposure levels above 25 μg/l and with more than 30 years of exposure to chlorinated water, but were mainly driven by the level rather than the duration of exposure. No significant association was found among women or with cumulative exposure through ingestion. There was no evidence of a differential exposure-response relation for TTHM and bladder cancer in Europe and North America. Consequently, a global exposure-risk relation based on 4351 cases and 7055 controls is now available.

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Occupational and Environmental Medicine

Tập 68 Số 5

379-385

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