This document summarizes research on the chronic health effects of arsenic exposure through drinking water in Chile. Studies found associations between high arsenic levels in drinking water and increased risks of various cancers, lung and heart diseases, and infant mortality. Arsenic levels were historically high in some regions of northern Chile due to natural contamination of drinking water sources. Long-term studies spanning decades found health risks persisted even after arsenic levels decreased, indicating long-term health impacts of early-life exposure.

1. Nuevas evidencias sobre los
efectos crónicos de la
exposición a arsénico en agua
potable en Chile.
Catterina Ferreccio Readi
Departamento de Salud Pública
www.saludpublicauc.cl
Pontificia Universidad Católica de Chile
Santiago 2013

2. Regiones del Norte de Chile
Lugar más
seco del
mundo
Pocas fuentes
de agua
Todos toman
agua de la misma
fuente
Hay registros históricos de
los niveles de As en todas las
fuentes de agua
+

3. Arsénico en agua potable 1950-04 (µg/L)
Años Antof. Tocopilla Calama
1930-57 90 250 150
1958-70 860 250 150
1971-77 110 636 287
1978-79 110 110 110
1980-87 70 110 110
1988-94 40 40 40
1995-03 40 40 40
2004-05 10 10 10

4. Prom ajustado de As ( g/L) agua Reg II, 50-94

5. Short term effects: Neonatal mortality rates for
Antofagasta and Valparaiso, 1950 to 1996.
Chronic Arsenic Exposure and Risk of Infant Mortality in Two Areas of Chile.
Environmental Health Perspectives 2000. 108 (1) 7

6. Late fetal mortality rates for Antofagasta and
Valparaiso, 1950 to 1996. Environmental Health Perspectives

7. 0.5
1
1.5
2
1950 1960 1970 1980 1990 2000
Year
RateRatios
Male Female
Acute Myocardial Infarction Mortality Region II of
Chile from 1950 to 2000
High As Exposure
Period
Yuan Y. et al. Am J Epidemiol. 2007.

10. Exposición
niñez
Expuesto sólo
como adultos

11. Mortalidad (SMRs) EPOC, edad 30-49 años,
expuestos in-utero o expuestos en la niñez
Smith AH, Marshall G, Yuan Y, Ferreccio C, Liaw J, von Ehrenstein OS, Steinmaus1, Bates MN, and Selvin
S. Environ Health Perspect 114:1293-96, 2006.

13. Evidence From Chile That Arsenic in
Drinking Water May Increase Mortality From
Pulmonary Tuberculosis
American Journal of Epidemiology

14. Mortality in young adults following in utero and
early childhood exposure to arsenic in drinking
water

15. RIESGO DE CANCER PULMONAR INTERACCION
ARSENICO/TABACO. Casos y Controles. 1994-1996

16. Smoking
category
Arsenic
(µg/L)a
Bladder cancer Lung cancer
OR OR
Never-smoker <11 1.00 1.00
11-91 2.66 0.68
92-335 7.01 0.93
>335 8.86 2.04
Heavier
smoker
<11 4.12 3.75
11-91 4.72 4.39
92-335 7.08 12.4
>335 23.21 16.26
OR for Bladder and Lung Cancer and Arsenic in Water,
by Smoking Status, Northern Chile, 2007-2010

17. Cancer OR; only cases histologically confirmed, non-
proxy, sex. Upper/lower quart avge lifetime As concentr
prior to 1971
OR adjusted for age, sex, smoking, mining work, race, body-mass index, and
SES. bladder ca OR in females of 23.6 (4.14-135.3) is truncated.

18. Lung Ca OR in Men by As an other
exposures, 2007-2010 (Epidem 2013)
Other
agent:
Exposed Unexposed Exposed
Synergy index
Arsenic:a Low exposure High exposure High exposure
OR (95% CI) OR (95% CI) OR (95% CI) S (95% CI)
Any
carcinogen
1.8 (0.6- 5.4) 5.2 (1.8-15.3) 12.1 (3.8-38.4) 2.2 (0.9-5.5)
Asbestos 1.6 (0.1-17.8) 6.0 (2.8-12.3) 16.2 (2.8-95.1) 2.7 (0.5-14.4)
Silica 1.8 (0.6- 5.6) 6.2 (2.6-14.8) 13.0 (3.9-42.8) 2.0 (0.8-5.2)
Wood dust 2.5 (0.8- 7.7) 7.6 (3.2-17.9) 26.5 (6.0-116.8) 3.1 (1.1-9.3)
Welding
fumes
1.0 (0.3- 3.2) 5.6 (2.4-12.8) 11.9 (3.7-38.1) 2.4 (0.8-7.1)
Coke oven 0.9 (0.2- 3.6) 6.0 (2.7-13.0) 6.5 (2.2-19.2) 1.1 (0.4-3.1)
Soot 1.7 (0.4- 6.5) 6.3 (2.9-13.5) 16.1 (2.2-117.0) 2.5 (0.6-11.3)
Fiberglass 1.4 (0.2- 7.4) 6.1 (2.9-12.8) 14.4 (2.6-80.6) 2.5 (0.6-10.9)

19. Kidney Cancer OR by As Intake and Histologic
Subtype, Chile, 2007-10
Type of cancer Renal pelvis & ureter Renal cell
Exposure
As
intake
Contr Case OR 95% CI
No.
Cases
OR 95% CI
Lifetime
average
(µg/day)
<48 219 1 1.00 26 1.00
48-167 211 3 4.68 0.3, 67.3 32 1.29 0.7. 2.3
>167 210 14 19.3 2.4, 154.4 23 1.01 0.5, 1.9
p-trend=0.0006 p-trend=0.98
Cum. expos
(mg)
Before
1971
<0.7 218 1 1.00 27 1.00
0.7-6.1 213 3 4.83 0.4, 60.6 28 1.27 0.7, 2.3
>6.1 205 14 19.0 2.4-152.7 24 1.24 0.7, 2.3
p-trend=0.0003 p-trend=0.5

20. Early-life As and lung function residuals (observed
minus predicted) and %of age-, sex-, and height-
predicted values (mean ± SD)
Peak arsenic before age 10
<50 μg/l
(n = 45)
50–250 μg/l
(n = 20)
>800 μg/l
(n = 32)
Percent predicted
FEV1
98.2 ± 14.6 91.2 ± 11.0 88.1 ± 18.3
Percent predicted
FVC
103.6 ± 16.7 98.2 ± 10.0 94.7 ± 15.3
FEV1 residual
(ml)
−63 ± 443 −270 ± 314 −375 ± 611
FVC residual (ml) 103 ± 584 −54 ± 380 −226 ± 614

21. Temas de investigación en desarrollo
• Duración del riesgo luego de detenida la
exposición
• Riesgo de otros cánceres como mama y
próstata
• Identificar bio-marcadores de riesgo para
detección precoz

22. Protección a la población expuesta
Prevención primaria:
1. As: mantener en el agua <10 ug/L
(Norma Regional menor?)
2. Reducir exposición al tabaco
3. Promover: frutas-verduras, actividad
física.
Prevención Secundaria
1. Alertar al cuerpo médico
2. Tamizaje?

23. References
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exposed northern chile. Am J Epidemiol. 2013 Sep 1;178(5):813-8.
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cessation. Cancer Epidemiol Biomarkers Prev. 2013 Apr;22(4):623-30. d
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drinking water: preliminary findings. Int Arch Occup Environ Health. 2011 Aug;84(6):591-600.
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mortality: fifty-year latency patterns related to arsenic exposure. Epidemiology. 2010
Jan;21(1):103-8.
• Liaw J, Increased childhood liver cancer mortality and arsenic in drinking water in northern Chile.
Cancer Epidemiol Biomarkers Prev. 2008 Aug;17(8):1982-7.
• Yuan Y, Acute myocardial infarction mortality in comparison with lung and bladder cancer
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15;166(12):1381-91.
• Marshall G, Fifty-year study of lung and bladder cancer mortality in Chile related to arsenic in
drinking water. J Natl Cancer Inst. 2007 Jun 20;99(12):920-8.

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