Assessment of cause-specific mortality and disability-adjusted life years (DALYs) induced by exposure to inorganic arsenic through drinking water and foodstuffs in Iran

• Published in: The Science of the total environment 2023-01, Vol.856, p.159118-159118, Article 159118
• Main Authors: Abtahi, Mehrnoosh, Dobaradaran, Sina, Koolivand, Ali, Jorfi, Sahand, Saeedi, Reza
• Format: Article
• Language: English
• Subjects: Environmental burden of disease; Exposure assessment; Food safety; Health outcome; Health risk assessment
• ISSN: 0048-9697; 1879-1026
• DOI: 10.1016/j.scitotenv.2022.159118

The health risk and burden of disease induced by exposure to inorganic arsenic (iAs) through drinking water and foodstuffs in Iran were assessed. The iAs levels in drinking water and foodstuffs (15 food groups) in the country were determined through systematic review of three international databases (PubMed, Scopus, and Web of Science) and meta-analysis. Based on the results of the systematic review and meta-analysis, the average iAs levels in drinking water and all the food groups at the national level were lower than the maximum permissible levels. The total average non-carcinogenic risk of dietary exposure to iAs in terms of hazard index (HI) was 3.4. The average incremental lifetime cancer risk (ILCR) values of dietary exposure to iAs were determined to be 1.5 × 10−3 for skin cancer, 1.0 × 10−3 for lung cancer, and 4.0 × 10−4 for bladder cancer. Over two-thirds of the non-carcinogenic and carcinogenic risk of dietary exposure to iAs was attributed to bread and cereals, drinking water, and rice. The total annual cancer incidence, deaths, disability-adjusted life years (DALYs), death rate, and DALY rate (per 100,000 people) were assessed to be 3347 (95 % uncertainty interval: 1791 to 5999), 1302 (697 to 2336), 72,606 (38,833 to 130,228), 1.6 (0.87 to 2.9), and 91 (49 to 160). The contribution of mortality in the attributable burden of disease was 95.1 %. The contributions of the causes in the attributable burden of disease were 72 % for lung cancer, 16 % for bladder cancer, and 12 % for skin cancer. Due to the significant attributable burden of disease, national and subnational action plans consisting of multi-disciplinary approaches for risk management of dietary exposure to iAs, especially for the higher arsenic-affected areas and high-risk population groups in the country are recommended. Annual burden of disease induced by dietary exposure to inorganic arsenic by food group and cause in Iran. [Display omitted] •Health risk and disease burden of dietary exposure to iAs in Iran were estimated.•The mean HI and total ILCR of dietary iAs exposure were respectively 3.4 and 0.0029.•The mean attributable DALY and DALY rate were respectively 72,606 and 91.•Over two thirds of the attributable burden of disease accounted for lung cancer.•About 70 % of the disease burden accounted for bread and cereals, drinking water, and rice.