2026-06-14T03:32:56Zhttps://repisalud.isciii.es/rest/oai/requestoai:repisalud.isciii.es:20.500.12105/164912025-05-23T14:56:43Zcom_20.500.12105_2052com_20.500.12105_2051com_20.500.12105_15322col_20.500.12105_19608col_20.500.12105_16961col_20.500.12105_16962col_20.500.12105_16970col_20.500.12105_16983col_20.500.12105_16990
Repisalud
author
Donat-Vargas, Carolina
author
Kogevinas, Manolis
author
Benavente, Yolanda
author
Costas, Laura
author
Campo, Elias
author
Castaño-Vinyals, Gemma
author
Fernandez-Tardon, Guillermo
author
Llorca, Javier
author
Gómez-Acebo, Inés
author
Aragones, Nuria
author
Pollan-Santamaria, Marina
author
Casabonne, Delphine
author
Villanueva, Cristina M
funder
Instituto de Salud Carlos III
funder
Unión Europea. Fondo Europeo de Desarrollo Regional (FEDER/ERDF)
funder
Fundación Marqués de Valdecilla
funder
Generalitat Valenciana (España)
funder
Unión Europea. Comisión Europea
funder
Asociación Española Contra el Cáncer
funder
Government of Catalonia (España)
funder
Agència de Gestió d´Ajuts Universitaris i de Recerca (AGAUR)
funder
Fundación Caja de Ahorros de Asturias
funder
University of Oviedo (España)
funder
Ministerio de Ciencia e Innovación. Centro de Excelencia Severo Ochoa (España)
2023-09-25T13:38:44Z
2023-09-25T13:38:44Z
2024
J Expo Sci Environ Epidemiol. 2024 Jan;34(1):47-57.
10.1038/s41370-023-00600-7
1559-064X
1559-0631
Journal of exposure science & environmental epidemiology
37726507
http://hdl.handle.net/20.500.12105/16491
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.
eng
Water contaminants
Trihalomethanes
Nitrate
Swimming pools
Cancer
Chronic lymphocytic leukemia
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)
research article
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LifetimeExposureBrominatedTrihalomethanes_2023.pdf
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LifetimeExposureBrominatedTrihalomethanes_2023.pdf.txt
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