Chronic exposure to inorganic arsenic (As) and uranium (U) in the United States (US) occurs from unregulated private wells and federally regulated community water systems (CWSs). The contribution of water to total exposure is assumed to be low when water As and U concentrations are low.
We examined the contribution of water As and U to urinary biomarkers in the Strong Heart Family Study (SHFS), a prospective study of American Indian communities, and the Multi-Ethnic Study of Atherosclerosis (MESA), a prospective study of racially/ethnically diverse urban U.S. communities.
We assigned residential zip code-level estimates in CWSs (µg/L) and private wells (90th percentile probability of As >10 µg/L) to up to 1485 and 6722 participants with dietary information and urinary biomarkers in the SHFS (2001–2003) and MESA (2000–2002; 2010–2011), respectively. Urine As was estimated as the sum of inorganic and methylated species, and urine U was total uranium. We used linear mixed-effects models to account for participant clustering and removed the effect of dietary sources via regression adjustment.
The median (interquartile range) urine As was 5.32 (3.29, 8.53) and 6.32 (3.34, 12.48) µg/L for SHFS and MESA, respectively, and urine U was 0.037 (0.014, 0.071) and 0.007 (0.003, 0.018) µg/L. In a meta-analysis across both studies, urine As was 11% (95% CI: 3, 20%) higher and urine U was 35% (5, 73%) higher per twofold higher CWS As and U, respectively. In the SHFS, zip-code level factors such as private well and CWS As contributed 46% of variation in urine As, while in MESA, zip-code level factors, e.g., CWS As and U, contribute 30 and 49% of variation in urine As and U, respectively.
We found that water from unregulated private wells and regulated CWSs is a major contributor to urinary As and U (an estimated measure of internal dose) in both rural, American Indian populations and urban, racially/ethnically diverse populations nationwide, even at levels below the current regulatory standard. Our findings indicate that additional drinking water interventions, regulations, and policies can have a major impact on reducing total exposures to As and U, which are linked to adverse health effects even at low levels.
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Investigators interested in analyzing MESA data can submit a paper proposal for consideration by the Publications and Presentations (P&P) Committee. The only requirement on an outside investigator is that a MESA investigator be a sponsor. Once a paper proposal has been approved, the lead investigator may request a dataset from the Coordinating Center. Investigators interested in analyzing SHS data can apply to use the data according to established protocol for SHS Resource and Data Sharing, including community approval through formal application (strongheart.ouhsc.edu/datarequest.html).
The statistical code for analysis is available upon reasonable request, please contact MS at email@example.com.
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This study was supported by NIEHS grants P42ES033719 and P30ES009089, R01ES028758, R01ES032638 and by the NIH Office Of The Director and National Institute Of Dental & Craniofacial Research (DP5OD031849). Research reported in this publication was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development under grant number P2CHD058486, awarded to the Columbia Population Research Center. MS is also supported by NIEHS grant F31ES034284. We would like to acknowledge Joseph Ayotte for his contributions to this study. The Strong Heart Study has been funded in whole or in part with federal funds from the National Heart, Lung, and Blood Institute, National Institute of Health, Department of Health and Human Services, under contract numbers 75N92019D00027, 75N92019D00028, 75N92019D00029, and 75N92019D00030. The study was previously supported by research grants: R01HL109315, R01HL109301, R01HL109284, R01HL109282, and R01HL109319 and by cooperative agreements: U01HL41642, U01HL41652, U01HL41654, U01HL65520, U01HL65521, R01HL090863, R01ES025216, and R01ES021367. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Indian Health Service (IHS). The Multi-Ethnic Study of Atherosclerosis (MESA) was supported by contracts 75N92020D00001, HHSN268201500003I, N01-HC-95159, 75N92020D00005, N01-HC-95160, 75N92020D00002, N01-HC-95161, 75N92020D00003, N01-HC-95162, 75N92020D00006, N01-HC-95163, 75N92020D00004, N01-HC-95164, 75N92020D00007, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168 and N01-HC-95169 from the National Heart, Lung, and Blood Institute, and by grants UL1-TR-000040, UL1-TR-001079, and UL1-TR-001420 from the National Center for Advancing Translational Sciences (NCATS). The authors thank the other investigators, the staff, and the participants of the MESA study for their valuable contributions. A full list of participating MESA investigators and institutions can be found at http://www.mesa-nhlbi.org. This paper has been reviewed and approved by the MESA Publications and Presentations Committee. Any use of trade, firm, or product names is for descriptive purposes only and does not imply endorsement by the U.S. Government.
The authors declare no competing interests.
This research was approved by the Institutional Review Boards at the participating institutions, and written informed consent was given by all participants. This paper has been cleared by the respective Tribal Research Review Boards and area Indian Health Service IRBs for the SHFS and by the Publications and Presentations Committee for MESA.
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For participants in New York, we matched residential zip code to the corresponding community water system (CWS) based on town name (all New York City, NYC, residents were assigned to the NYC Public Water System, PWSID NY7003493). While CWS arsenic (As) data was available for Multi-Ethnic Study of Atherosclerosis (MESA) participants residing in New York City and nearby, corresponding CWS uranium (U) data were not available. We assigned the 2000–2011 CWS U estimate for a neighboring water system (Westchester County Water District #1, CWS U = 0.63 µg/L30) to New York City participants, based on personal communication from the Westchester County Department of Health (Alex Sciacchitano, oral communication, November 2022) that the Water District has the same aqueduct/source water supply as New York City.
Though Maryland did not provide adequate data to the US Environmental Protection Agency’s (EPA’s) Six Year Review of Contaminant Occurrence Database, water quality data for Baltimore City are publicly available online . We assigned participants residing in Baltimore City, and areas of the surrounding counties that are expected to be served by the City of Baltimore CWS , to the As estimate for the City of Baltimore CWS (concentration was <reporting level so imputed as 0.35 µg/L, according to previously published methods) [24, 43]. There were no U data reported for the City of Baltimore CWS
We performed several sensitivity analyses. To make our findings available to inform future risk assessments, we repeated our analyses after transforming assigned water As and U into estimated average daily dose using a standard exposure assessment framework used by the US EPA . We calculated average daily dose (mg/kg body weight (BW)-day) of As and U consumed from tap water using the following equation from the exposure assessment framework:
We used standard intake rate estimates of water consumption in US populations surveyed for NHANES . The dose intake rates (cups/day) for females were: 1.6, 2.5, 2.7, and 2.6, aged 12–19 years, 20–39 years, 40–59 years, and ≥60 years, respectively . The dose intake rates (cups/day) for males were: 2.3, 2.9, 2.8, and 2.1, aged 12–19 years, 20–39 years, 40–59 years, and ≥60 years, respectively.
Finally, we compared findings using area-weighted ZCTA-level CWS As and U estimates (instead of population-weighted ZCTA-level CWS estimates), also with similar results. Area weights were generated for each CWS within a ZCTA using the area of overlap between CWS service areas and ZCTAs. Area weights were applied using the “weighted.mean” function in R to create area-weighted average estimates of CWS As and U grouped at the ZCTA level.
Any use of trade, firm, or product names is for descriptive purposes only and does not imply endorsement by the U.S. Government.
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Spaur, M., Glabonjat, R.A., Schilling, K. et al. Contribution of arsenic and uranium in private wells and community water systems to urinary biomarkers in US adults: The Strong Heart Study and the Multi-Ethnic Study of Atherosclerosis. J Expo Sci Environ Epidemiol (2023). https://doi.org/10.1038/s41370-023-00586-2