MORTALITY IN YOUNG ADULTS FOLLOWING IN UTERO AND CHILDHOOD EXPOSURE
After reading the case study answer the questions provided below.
MORTALITY IN YOUNG ADULTS FOLLOWING IN UTERO AND CHILDHOOD EXPOSURE
TO ARSENIC IN DRINKING WATER.
Smith AH1, Marshall G, Liaw J, Yuan Y, Ferreccio C, Steinmaus C.
BACKGROUND:
Beginning in 1958, the city of Antofagasta in northern Chile was exposed to high arsenic
concentrations (870 μg/L) when it switched water sources. The exposure abruptly
stopped in 1970 when an arsenic-removal plant commenced operations. A unique
exposure scenario like this–with an abrupt start, clear end, and large population
(125,000 in 1970), all with essentially the same exposure–is rare in environmental
epidemiology. Evidence of increased mortality from lung cancer, bronchiectasis,
myocardial infarction, and kidney cancer has been reported among young adults who
were in utero or children during the high-exposure period.
OBJECTIVE:
We investigated other causes of mortality in Antofagasta among 30- to 49-year-old
adults who were in utero or ≤ 18 years of age during the high-exposure period.
METHODS:
We compared mortality data between Antofagasta and the rest of Chile for people 30-
49 years of age during 1989-2000. We estimated expected deaths from mortality rates
in all of Chile, excluding Region II where Antofagasta is located, and calculated
standardized mortality ratios (SMRs).
RESULTS:
We found evidence of increased mortality from bladder cancer [SMR = 18.1; 95%
confidence interval (CI): 11.3, 27.4], laryngeal cancer (SMR = 8.1; 95% CI: 3.5, 16.0), liver
cancer (SMR = 2.5; 95% CI: 1.6, 3.7), and chronic renal disease (SMR = 2.0; 95% CI: 1.5,
2.8).
CONCLUSIONS:
Taking together our findings in the present study and previous evidence of increased
mortality from other causes of death, we conclude that arsenic in Antofagasta drinking
water has resulted in the greatest increases in mortality in adults < 50 years of age ever
associated with early-life environmental exposure.
Environ Health Perspect. 2012 Nov;120(11):1527-31. doi: 10.1289/ehp.1104867.
Epub 2012 Sep 4.
What is the epidemiologic study design?
(a) Identify the exposure(s) of interest (independent variables) and (b) the outcome(s) (dependent variables) of interest in the study.
(a) Suggest at least one possible bias (systematic error) that might be present in each study. Pay particular attention to how subjects were selected, and what information was gathered from them and how it was collected. (b) Explain specifically how this could introduce bias into the study.
(a) Suggest one or more possible confounding factors related to the data collected and analyzed in the study, and (b) explain how it/they might confound interpretation of the authors’ findings.
(a) Suggest Two other epidemiologic study design that could address the same question(s), and (b) discuss the relative strengths and limitations of the other study design compared to the one actually used.
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