Arsenic in drinking water and adult mortality: a population-based cohort study in rural Bangladesh

Epidemiology. 2009 Nov;20(6):824-30. doi: 10.1097/EDE.0b013e3181bb56ec.


Background: Arsenic is a potent human carcinogen and toxicant. Elevated concentration of arsenic in drinking water is a major public-health problem worldwide. We evaluated risks of adult mortality (due to cancer and cardiovascular and infectious diseases) in relation to arsenic exposure through drinking water.

Methods: A cohort analysis was applied to survival data prospectively collected during 1991-2000 in a health and demographic surveillance system in Matlab, Bangladesh, where tubewells were installed beginning in the early 1970s. A total of 115,903 persons aged 15 or more years on 1 January 1991 were available for analysis. In this period, 9015 people died and 22,488 were lost to follow-up. Arsenic exposure data were derived from a survey in 2002-2003 of past and current water use and arsenic concentrations in all tubewells. We estimated risk of excess mortality in relation to arsenic exposure, using proportional hazards models.

Results: Even at low levels (10-49 mug/L) of arsenic in drinking water, we observed increased risk of death due to all nonaccidental causes (hazard ratio = 1.16 [95% confidence interval = 1.06-1.26]). Increased risks at exposure of 50-149 microg/L were observed for death due to cancers (1.44 [1.06-1.95]), cardiovascular disease (1.16 [0.96-1.40]), and infectious diseases (1.30 [1.13-1.49]). We observed clear dose-response relationships for each of these causes.

Conclusions: Arsenic exposure through drinking water has generated excess adult mortality after 20-30 years of exposure.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Arsenic / adverse effects*
  • Arsenic / analysis
  • Bangladesh
  • Cohort Studies
  • Female
  • Humans
  • Male
  • Middle Aged
  • Mortality / trends*
  • Proportional Hazards Models
  • Public Health
  • Risk Assessment
  • Rural Population*
  • Water Supply / analysis*
  • Young Adult


  • Arsenic