A prospective study of the synergistic effects of arsenic exposure and smoking, sun exposure, fertilizer use, and pesticide use on risk of premalignant skin lesions in Bangladeshi men

Am J Epidemiol. 2011 Jan 15;173(2):183-91. doi: 10.1093/aje/kwq357. Epub 2010 Nov 23.


Skin lesions are classic clinical signs of toxicity due to long-term exposure to arsenic, and they are considered precursors to arsenic-related skin cancer. The authors prospectively evaluated synergisms between effects of arsenic exposure and those of tobacco use, sun exposure, and pesticide and fertilizer use on incident skin lesions using risk factor data from 5,042 men from the Health Effects of Arsenic Longitudinal Study in Araihazar, Bangladesh, which recruited participants from October 2000 to May 2002. Discrete time hazard models were used to estimate measures of synergistic interactions on the additive scale. The authors observed significant synergistic effects between various measures of arsenic exposure and smoking and fertilizer use. The relative excess risks for the interactions between smoking status and arsenic exposure were 0.12 (95% confidence interval: 0.06, 0.19) for water arsenic and 0.11 (95% confidence interval: 0.05, 0.15) for urinary arsenic measures, respectively. Significant synergistic effects were also observed between fertilizer use and water arsenic (relative excess risk for the interaction = 0.06, 95% confidence interval: 0.01, 0.12). This is the first prospective study based on individual-level data that supports a role for smoking and certain occupational risk factors in modification of the effect of long-term arsenic exposure on skin lesions. Understanding differential arsenic susceptibility allows researchers to develop interventions to prevent the health consequences of this massive problem in the Bangladeshi population and beyond.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Arsenic / adverse effects*
  • Bangladesh / epidemiology
  • Fertilizers / adverse effects
  • Humans
  • Male
  • Middle Aged
  • Occupational Exposure*
  • Pesticides / adverse effects
  • Precancerous Conditions / chemically induced*
  • Precancerous Conditions / epidemiology
  • Prospective Studies
  • Skin Diseases / chemically induced*
  • Skin Diseases / epidemiology
  • Smoking / adverse effects*
  • Sunlight / adverse effects
  • Young Adult


  • Fertilizers
  • Pesticides
  • Arsenic