Potential Exposure Characteristics and Self-Reported Symptom Burden in a Romanian Region with Heterogeneous...

Environmental contamination by potentially toxic elements remains a public health concern in groundwater-dependent regions. This exploratory community-based cross-sectional study examined associations among a historical area-level arsenic screening classification, questionnaire-derived potential-exposure indicators, and self-reported symptom count in 275 adults from 37 standardized locality clusters in Satu Mare County, Romania. The arsenic Health Risk Index (HRI) screening classification was derived entirely from drinking-water measurements collected in a preceding regional study during 2022-2024; no water samples or exposure biomarkers were obtained in the present survey. The questionnaire-derived potential exposure index was calculated as the unweighted sum of seven binary indicators covering residential, drinking-water, occupational, dental, and dietary characteristics (theoretical range, 0-7; observed range, 0-6) and was analyzed continuously. Symptom count (theoretical range, 0-8) was analyzed primarily using negative binomial regression with locality-clustered standard errors and adjustment for age, sex, smoking, alcohol consumption, HRI classification, and self-reported comorbidity. Each one-point increase in the potential exposure index was associated with a modestly higher expected symptom count (adjusted incidence rate ratio = 1.106, 95% CI: 1.031-1.186; p = 0.005), whereas the area-level HRI classification was not statistically associated with symptom count (adjusted incidence rate ratio = 1.135, 95% CI: 0.829-1.554; p = 0.431). The association remained positive across alternative index specifications, although the drinking-water-focused estimate was smaller and less precise. These findings represent exploratory associations between reported potential-exposure characteristics and nonspecific self-reported symptoms; they do not establish individual arsenic exposure, contaminant-specific effects, or causality.