© 1998 Oxford University Press
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Arsenic levels in drinking water and the prevalence of skin lesions in West Bengal, India
aInstitute of Post Graduate Medical Education and Research 244 Acharya Jagadlsh Chandra Bnse Road, Calcutta 700020, India
bSchool of Public Health. University of California Berkeley, CA 94720-7360, USA
cSchool of Environmental Studies. Jadavpur University Calcutta 700032. India
Reprint requests to: Dr Allan H Smith
BACKGROUND: A cross-sectional survey was conducted between April 1995 and March 1996 to investigate arsenic-associated skin lesions of keratosis arid hyperpigmentation in West Bengal, India, and to determine their relationship to arsenic water levels.
METHODS: In all, 7683 participants were examined and interviewed, and the arsenic levels in their drinldng water measured.
RESULTS: Although water concentrations ranged up to 3400 µg/l of arsenic, over 80% of participants were consuming water containing <500 µg/l. The age-adjusted prevalence of keratosis was strongly related to water arsenic levels, rising from zero in the lowest exposure level (<50 µg/l) to 8.3 per 100 for females drinking water containing >800 µg/l, and increasing from 0.2 per 100 in the lowest exposure category to I0.7 per 100 for males in the highest exposure level (
800 µg/l). However, 12 cases with keratosis (2 females and 10 males) were drinking water containing <100 µg/l of arsenic. Findings were similar for hyperpigmentation, with strong dose-response relationships. Among those with hyperpigmentation, 29 cases were exposed to drinking water containing <100 µg/l. Calculation by dose per body weight showed that men had roughly two to three times the prevalence of both keratosis and hyperpigmentation compared to women apparently ingesting the same dose of arsenic from drinking water. Subjects who were below 80% of the standard body weight for their age and sex had a 1.6 fold increase in the prevalence of keratoses, suggesting that malnutrition may play a small role in increasing susceptibility.
CONCLUSION: The surprising finding of cases who had arsenic-associated skin lesions with apparently low exposure to arsenic in drinking water needs to be confirmed in studies with more detailed exposure assessment. Further research is also needed concerning susceptibility factors which might be present in the exposed population.
Keywords Arsenic, keratosis, hyperpigmentation, India, cross-sectional study, drinking water
Accepted 22 December 1997
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