近日，美国纽约大学格罗斯曼医学院Yu Chen团队研究了砷暴露减少与慢性病死亡率的关联。这一研究成果发表在2025年11月17日出版的《美国医学会杂志》上。

长期接触饮用水中的砷与慢性病死亡率增加有关。然而，关于减少接触与死亡风险之间关系的证据有限。

为了研究使用尿砷水平测量的砷暴露减少是否与包括癌症和心血管疾病（CVD）在内的慢性疾病死亡率降低有关，2000年至2002年期间，研究组在孟加拉国阿拉伊哈扎尔招募了11746名成年人的前瞻性队列，井水砷含量从低于1微克/升到864微克/升不等（平均102微克/升），超过了孟加拉国50微克/升的标准。由于社区的缓解措施，砷含量随着时间的推移而下降。死亡率一直追踪到2022年。分析包括10977名尿砷水平可计算变化的参与者。到2018年，每个参与者最多测量了5次尿砷水平。参与者根据尿中砷含量的变化进行分类。主要结局为慢性疾病（包括癌症和心血管疾病）死亡率的校正风险比（aHRs）和95%CI。

在10977名参与者（女性占57%；平均年龄37.0[标准差10.1]岁）中，平均尿液砷含量从2000年的283（标准差314）μg/g肌酐下降至2018年的132（标准差161）μg/g肌酐。尿液砷每降低一个四分位数间距（197 μg/g肌酐），慢性病死亡率降低22%（调整后风险比0.78[95%置信区间0.75-0.82]），癌症死亡率降低20%（aHR 0.80[0.73-0.87]），心血管疾病死亡率降低23%（aHR 0.77[0.73-0.81]）。时变Cox模型和限制性立方样条分析显示，砷含量降幅越大死亡率越低，而含量升高则与风险增加相关。与持续高尿液砷水平组（高于基线中位数199 μg/g肌酐[n=1757]）相比，水平降至中位数以下者（n=3757）慢性病死亡率更低（aHR 0.46[0.39-0.53]），其中癌症（aHR 0.51[0.35-0.73]）和心血管疾病（aHR 0.43[0.34-0.53]）死亡率降低幅度与持续低于中位数组（n=4959）相当（aHR 0.43-0.49）。倾向评分匹配分析结果与此一致。

研究结果表明，这些发现支持在接触受污染饮用水的人群中，减少砷接触与改善健康结果之间存在关联。

附：英文原文

Title: Arsenic Exposure Reduction and Chronic Disease Mortality

Author: Fen Wu, Alexander van Geen, Joseph Graziano, Kazi Matin Ahmed, Mengling Liu, Maria Argos, Faruque Parvez, Imtiaz Choudhury, Vesna N. Slavkovich, Tyler Ellis, Tariqul Islam, Alauddin Ahmed, Muhammad G. Kibriya, Farzana Jasmine, Mohammad Hasan Shahriar, Rabiul Hasan, Salma Akter Shima, Golam Sarwar, Ana Navas-Acien, Habibul Ahsan, Yu Chen

Issue&Volume: 2025-11-17

Abstract:

Importance  Chronic exposure to arsenic in drinking water has been associated with increased chronic disease mortality. However, there is limited evidence on associations between reduced exposure and mortality risk.

Objective  To examine whether reductions in arsenic exposure, measured using urinary arsenic levels, are associated with lower mortality from chronic diseases, including cancer and cardiovascular disease (CVD).

Design, Setting, and Participants  A prospective cohort of 11746 adults was enrolled between 2000 and 2002 in Araihazar, Bangladesh, with levels of well-water arsenic ranging from less than 1 μg/L to 864 μg/L (mean, 102 μg/L), exceeding the Bangladesh standard of 50 μg/L. Arsenic levels declined over time as a result of community mitigation. Mortality was tracked through 2022. Analyses included 10977 participants with calculable changes in urinary arsenic levels.

Exposures  Urinary arsenic levels were measured up to 5 times per participant through 2018. Participants were categorized based on changes in urinary arsenic levels.

Main Outcomes and Measures  Adjusted hazard ratios (aHRs) and 95% CIs for mortality from chronic diseases, including cancer and CVD.

Results  Among 10977 participants (57% female; mean age, 37.0 [SD, 10.1] years), mean urinary arsenic levels declined from 283 (SD, 314) to 132 (SD, 161) μg/g creatinine from 2000 to 2018. Each IQR decrease in urinary arsenic (197 μg/g creatinine) was associated with 22% lower chronic disease mortality (aHR, 0.78 [95% CI, 0.75-0.82]), 20% lower cancer mortality (aHR, 0.80 [95% CI, 0.73-0.87]), and 23% lower CVD mortality (aHR, 0.77 [95% CI, 0.73-0.81]). Time-varying Cox and restricted cubic spline analyses showed larger reductions were associated with lower mortality, while increases were linked to higher risk. Compared with participants with consistently high urinary arsenic levels (above the baseline median of 199 μg/g creatinine [n=1757]), those whose levels declined below the median (n=3757) had lower mortality from chronic diseases (aHR, 0.46 [95% CI, 0.39-0.53]), including cancer (aHR, 0.51 [95% CI, 0.35-0.73]) and CVD (aHR, 0.43 [95% CI, 0.34-0.53]), similar to those consistently below the median (n=4959) (aHR, 0.43-0.49). Findings were similar in propensity score–matched analyses.

Conclusions and Relevance  These findings support an association between reduced arsenic exposure and improved health outcomes in populations exposed to contaminated drinking water.

DOI: 10.1001/jama.2025.19161

Source: https://jamanetwork.com/journals/jama/fullarticle/2841553