Thallium Contamination of Drinking Water: Health Implications in a Residential Cohort Study in Tuscany (Italy)

Int J Environ Res Public Health. 2021 Apr 12;18(8):4058. doi: 10.3390/ijerph18084058.


In 2014-2015, concentrations of thallium above the recommended reference value (EPA: 2 µg/L) were measured in some parts of the drinking water distribution system in the municipality of Pietrasanta (Tuscany, Italy). An extensive campaign of water samples and human biomonitoring surveys were implemented to quantify the exposure of population. A residential cohort epidemiological study was carried out on the population of the municipality of Pietrasanta, aimed at comparing the health status of residents in the areas affected by thallium contamination with residents living in the rest of the municipality. Cohort included people residing in the municipality of Pietrasanta from 1 January 2000 to 31 December 2015. Residence addresses were georeferenced and each subject living in one of the three contaminated areas were defined as exposed. Mortality, hospital discharge data and adverse pregnancy outcomes were taken from administrative health databases. Cox proportional hazard models and logistic models were used to test the association between thallium exposure and health outcome. This study did not show any excess of risk in terms of mortality and hospitalization in the population residing in the areas served by thallium-contaminated aqueduct branches, compared to the rest of the not contaminated area. Increased risks for low birth weight (OR = 1.43 95% CI 0.91-2.25) and pre-term birth (OR = 1.40 95% CI 0.82-2.37) were observed. In view of the paucity of epidemiological studies on thallium, this study is an important contribution to the state of knowledge of the health effects of chronic exposures to low concentrations of thallium.

Keywords: contaminated sites; drinking water; mines sites; mortality; residential cohort study; thallium; water safety plan.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cities
  • Cohort Studies
  • Drinking Water*
  • Environmental Exposure / analysis
  • Female
  • Humans
  • Italy / epidemiology
  • Pregnancy
  • Thallium / analysis
  • Water Pollutants, Chemical* / analysis
  • Water Pollutants, Chemical* / toxicity


  • Drinking Water
  • Water Pollutants, Chemical
  • Thallium