Lifetime exposure to brominated trihalomethanes in drinking water and swimming pool attendance are associated with chronic lymphocytic leukemia: a Multicase-Control Study in Spain (MCC-Spain)

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• dc.contributor.author Donat-Vargas, Carolina
• dc.contributor.author Kogevinas, Manolis
• dc.contributor.author Benavente, Yolanda
• dc.contributor.author Costas, Laura
• dc.contributor.author Campo, Elias
• dc.contributor.author Castaño Vinyals, Gemma
• dc.contributor.author Fernandez-Tardon, Guillermo
• dc.contributor.author Llorca, Javier
• dc.contributor.author Gómez-Acebo, Inés
• dc.contributor.author Aragonés, Núria
• dc.contributor.author Pollan, Marina
• dc.contributor.author Casabonne, Delphine
• dc.contributor.author Villanueva Belmonte, Cristina
• dc.date.accessioned 2023-12-11T06:37:15Z
• dc.date.available 2023-12-11T06:37:15Z
• dc.date.issued 2023
• dc.description.abstract Background: Chronic lymphocytic leukemia (CLL) etiology is poorly understood, and carcinogenic chemicals in drinking and recreational water are candidates. Objective: To evaluate the association between drinking-water exposure to trihalomethanes (THMs) and nitrate as well as lifetime swimming pool attendance and CLL. Methods: During 2010-2013, hospital-based CLL cases and population-based controls were recruited in Spain, providing information on residential histories, type of water consumed and swimming pool attendance. Average THMs and nitrate levels in drinking water were linked to lifetime water consumption. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using mixed models. Results: Final samples for residential tap water analyses and swimming pool attendance analyses were 144 cases/1230 controls and 157 cases/1240 controls, respectively. Mean (SD) values for average lifetime residential brominated THMs and chloroform in tap water (μg/L), and ingested nitrate (mg/day) were 48.1 (35.6), 18.5 (6.7) and 13.7 (9.6) respectively in controls; and 72.9 (40.7), 17.9 (5.4), and 14.1 (8.8) in CLL cases. For each 10 μg/L increase of brominated THMs and chloroform lifetime-average levels, the ORs (95% CI) were 1.22 (1.14, 1.31) and 0.54 (0.34, 0.87), respectively. For each 5 mg/day increase of ingested nitrate, the OR of CLL was 0.91 (0.80, 1.04). The OR of lifetime pool users (vs. non-users) was 2.38 (1.61, 3.52). Upon performing annual frequency of attending pools analysis through categorization, the second and third categories showed an ORs of 2.36 (1.49, 3.72) and 2.40 (1.51, 3.83), respectively, and P-trend of 0.001. Impact statement: This study identifies an association of long-term exposure to THMs in drinking water, at concentrations below the regulatory thresholds and WHO guidelines, and swimming pool attendance, with chronic lymphocytic leukemia (CLL). These unprecedented findings are highly relevant since CLL is an incurable cancer with still unknown etiology and because the widespread exposure to chlorination by-products that remain in drinking and recreational water worldwide. Despite the demonstrated carcinogenicity in animals of several chlorination by-products, little is known about their potential risks on human health. This study makes a significant contribution to the search for environmental factors involved in the etiology of CLL and to the evidence of the health impact of these high prevalent water contaminants.
• dc.description.sponsorship The study was partially funded by the “Accion Transversal del Cancer”, approved on the Spanish Ministry Council on the 11th October 2007, by the Instituto de Salud Carlos III-FEDER (PI08/1770, PI08/0533, PI08/1359, PS09/00773, PS09/01286, PS09/01903, PS09/02078, PS09/01662, PI11/01889, PI11/00226, PI12/01270, PI12/00715, PI14/0613, PI15/00914, PI17CIII/00034), by the Fundación Marqués de Valdecilla (API 10/09), by the Conselleria de Sanitat of the Generalitat Valenciana (AP_061/10), by the European Commission grants FOOD-CT-2006-036224-HIWATE, by the Spanish Association Against Cancer (AECC) Scientific Foundation, by the Catalan Government- Agency for Management of University and Research Grants (AGAUR) grants 2017SGR723, 2021SGR01354 and 2014SGR850, by the Fundación Caja de Ahorros de Asturias and by the University of Oviedo. ISGlobal acknowledges support from the Spanish Ministry of Science and Innovation through the “Centro de Excelencia Severo Ochoa 2019-2023” Program (CEX2018-000806-S), and support from the Generalitat de Catalunya through the CERCA Program.
• dc.format.mimetype application/pdf
• dc.identifier.citation Donat-Vargas C, Kogevinas M, Benavente Y, Costas L, Campo E, Castaño-Vinyals G, Fernandez-Tardon G, Llorca J, Gómez-Acebo I, Aragonés N, Pollan M, Casabonne D, Villanueva CM. Lifetime exposure to brominated trihalomethanes in drinking water and swimming pool attendance are associated with chronic lymphocytic leukemia: a Multicase-Control Study in Spain (MCC-Spain). J Expo Sci Environ Epidemiol. 2023 Sep 19. DOI: 10.1038/s41370-023-00600-7
• dc.identifier.doi http://dx.doi.org/10.1038/s41370-023-00600-7
• dc.identifier.issn 1559-0631
• dc.identifier.uri http://hdl.handle.net/10230/58467
• dc.language.iso eng
• dc.publisher Nature Research
• dc.relation.ispartof J Expo Sci Environ Epidemiol. 2023 Sep 19
• dc.relation.projectID info:eu-repo/grantAgreement/ES/2PE/CEX2018-000806-S
• dc.rights © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
• dc.rights.accessRights info:eu-repo/semantics/openAccess
• dc.rights.uri http://creativecommons.org/licenses/by/4.0/
• dc.subject.keyword Cancer
• dc.subject.keyword Chronic lymphocytic leukemia
• dc.subject.keyword Nitrate
• dc.subject.keyword Trihalomethanes
• dc.subject.keyword Water contaminants
• dc.subject.keyword Swimming pools
• dc.title Lifetime exposure to brominated trihalomethanes in drinking water and swimming pool attendance are associated with chronic lymphocytic leukemia: a Multicase-Control Study in Spain (MCC-Spain)
• dc.type info:eu-repo/semantics/article
• dc.type.version info:eu-repo/semantics/publishedVersion