Association between multi-level inorganic arsenic exposure from drinking water and skin lesions in China

Arsenic is one of the most important toxicants in the environment. In Inner Mongolia of China, 300,000 residents are believed to be drinking water containing >50 microg/liter. Skin lesions have been known as the most common consequences resulting from chronic exposure to arsenic. To clarify the prevalence of arsenic-induced skin lesions, it is important to assess the impact of this problem among the target population, and to make future planning. We evaluated the association between multi-levels inorganic arsenic exposure from drinking water and skin lesions in an arsenic-affected area in Inner Mongolia, China. One hundred nine and 32 subjects in high (>50 microg/liter) and low (<50 microg/liter) arsenic-affected villages were recruited and had the detailed physical examination with special emphasis on arsenic-related skin lesions. Arsenic exposure was measured for each participant with respect to iAs concentration of primary well and the duration using the well. Arsenic-induced skin lesions including keratosis, pigmentation, and/or depigmentation were diagnosed in 56 and 3 subjects in the two villages, respectively. Logistic regression was conducted to calculate odd ratios of skin lesions associated with arsenic exposure with adjustments for sex, age group, smoking and duration of exposure. A consistent dose-response relationship between arsenic exposure level and skin lesion risk was observed. Compared to those with iAs concentration <50 microg/liter, the adjusted odds ratios of skin lesions for the subjects with 51-99, 100-149 and >150 microg/liter were 33.3% (OR =15.50, 95% CI: 1.53-248.70), 46.7% (OR =16.10, 95% CI: 3.73-69.63) and 55.7% (OR= 25.70, 95% CI: 6.43-102.87), respectively. Duration of using well was not associated with increased risk of skin lesions in this population; (OR =1.68, 95% CI: 0.40-6.91 for 6-15 years, OR = 2.30, 95% CI: 0.58-9.14 for over 15 years) compared with the duration of less than 5 years.