ABSTRACT
Objective:To understand all causes mortality and cancer mortality of residents in drinking-water-borne endemic arsenism areas 10 to 16 years after water-improvement, and to evaluate the effects of water-improvement on prevention and treatment of the long-term harm of arsenic poisoning.Methods:In April 2020, in drinking-water-borne endemic arsenism areas of Ying County and Shanyin County, Shanxi Province, the diseased villages where water-improvement was carried out in 2003 were selected, and the permanent residents of the survey sites were selected as arsenic-exposure group. The residents in non-diseased villages were selected as control group. All causes and cancer deaths from 2013 to 2019 of the two groups were investigated and analyzed.Results:In arsenic-exposure group, the range of arsenic concentration in drinking water before water-improvement was 0.060 to 0.345 mg/L, and that after water-improvement was 0.000 17 to 0.003 60 mg/L. During the 7 years, a total of 94 128 person years were investigated in arsenic-exposure group and 102 086 person years in control group. There were 828 deaths from all causes in arsenic-exposure group, with a crude mortality rate of all causes of 8.80‰ and a standardized mortality rate of 9.16‰. There were 637 deaths from all causes in control group, with a crude mortality rate of all causes of 6.24‰ and a standardized mortality rate of 6.91‰. The crude mortality rate of all causes in arsenic-exposure group was higher than that in control group (χ 2 = 43.20, P < 0.01). Totally 218 deaths from cancer were reported in arsenic-exposure group, with a cancer crude mortality rate of 231.60/100 000 and a standardized mortality rate of 231.67/100 000. Totally 164 deaths from cancer were reported in control group, with a cancer crude mortality rate of 160.65/100 000 and a standardized mortality rate of 175.97/100 000. The cancer crude mortality rate in arsenic-exposure group was higher than that in control group (χ 2 = 12.69, P < 0.01). The median age of cancer deaths in the two groups was 72.0 and 68.5 years, respectively, and the difference was not statistically significant ( P > 0.05). The cancer crude mortality rate among males in arsenic-exposure group was 317.16/100 000, which was higher than that of males in control group (198.91/100 000, χ 2 = 14.21, P < 0.01), but there was no difference between females in the two groups (134.10/100 000 vs 118.03/100 000, P > 0.05). The highest cancer crude mortality rate in arsenic-exposure group and control group was lung cancer, which were 115.80/100 000 and 69.55/100 000, respectively. The crude mortality rates of lung cancer, stomach cancer and bladder cancer in arsenic-exposure group were higher than those in control group (χ 2 = 11.43, 4.33, 5.05, P < 0.01 or < 0.05), while the crude mortality rates of other cancers were not significantly different between the two groups ( P > 0.05). Conclusions:Simply taking water-improvement measure can't block the long-term health burdens of arsenic exposure, especially for carcinogenic effect. Health follow-up management and disease prevention measures in arsenic-exposed areas will be needed for decades after exposure cessation.
ABSTRACT
Objective:To master the changing trend of drinking-water-borne endemic arsenic poisoning in Shanxi Province and the implementation of prevention and control measures, to evaluate the progress of elimination target, and to provide objective basis for the implementation of refined management.Methods:In 2018, according to the mid-term evaluation plan of the "Thirteenth Five-Year Plan for National Endemic Disease Control" and the requirements of the "Measures for Elimination Control and Evaluation of Key Endemic Diseases", in 157 disease affected villages or high arsenic villages of 16 counties (cities, districts) in the province, taking the administrative village as the unit, a census of all permanent residents was conducted to investigate the condition of current patients and find out the new cases of arsenic poisoning; the implementation of water improvement measures and the operation of water improvement project were investigated; one tap water sample was collected from each administrative village to detect the arsenic content in the water; and the elimination of arsenic poisoning was evaluated.Results:A total of 1 221 cases of drinking-water-borne endemic arsenic poisoning were investigated in the whole province, including 982 mild cases, 190 moderate cases and 49 severe cases, accounting for 80.43%, 15.56% and 4.01%, respectively; all the 1 221 cases were monitored and registered before 2011, no new cases were found. In the 157 investigated villages, the rate of water improvement was 94.90% (149/157), the average content of arsenic in water of village with water improvement was 0.022 3 mg/L, ranging from 0.000 5 to 0.193 9 mg/L; the qualified rate of water arsenic after water improvement was 83.89% (125/149), and the normal operation rate of water improvement project was 82.55% (123/149). Ten counties (cities, districts) had reached the elimination standard, and six counties (cities) had not reached the elimination standard.Conclusions:The prevention and control effect of control measures on drinking-water-borne endemic arsenic poisoning in Shanxi Province is remarkable, and there is no new case for many years. In the future, efforts should be made to improve water supply, carry out one village one policy refined management, ensure that all disease affected villages or high arsenic villages meet the national elimination standards, and achieve the goal of the special three-year program for prevention and control of endemic diseases.
ABSTRACT
Objective To evaluate the effect of water improvement projects on drinking-water-borne endemic arsenism in Shanxi Province,to work out and refine sustainable prevention and control strategies.Methods The operating situation of water-improvement projects was investigated and monitored,and the arsenic content in drinking water was determined in drinking-water-borne arseniasis areas,which including 14 monitored sites in 5 countries from 2012 to 2017.The condition of arsenic poisoning in the resident population of the monitored sites was investigated and the arsenic content in the urine of patients was determined.Results Totally 14 monitored sites were already finished water improvement,the rate of water-improvement was 100％.Totally 11 water-improvement projects were monitored,including 7 small-scale water-improvement projects and 4 large-scale water-improvement projects,which all qualified and operated normally from 2012 to 2015.In 2016,one water-improvement project was found with excessive level (＞ 0.01 mg/L) of arsenic in drinking water in Shanyin County,and the other 10 water-improvement projects' arsenic contents were qualified.In 2017,two unqualified large-scale water-improvement projects had water arsenic content over (＞ 0.01 mg/L) in Shanyin County and Ying County,respectively.And the other 9 water-improvement projects were qualified.The detection rates of arsenic poisoning from 2012 to 2017 were 1.36％ (104/7 641),1.57％ (123/7 832),1.61％ (123/7 621),1.53％ (120/7 857),1.28％ (102/7 963) and 1.56％ (124/7 958),respectively,and the differences were not statistically significant (x2 =4.979 9,P ＞0.05).Most patients with arsenic poisoning were mild to moderate patients,accounted for 82.61％ (575/696) and no new case was detected.Conclusions Arsenic poisoning in drinking-water-borne arseniasis areas in Shanxi Province has been controlled.Natural operation of water-improvement projects has kept water arsenic levels normal.Water arsenic content has exceeded the standard in some of the water-improvement projects.The key point of next stage is strengthen the management of water improvement projects in prevention and treatment of drinking-water type endemic arsenism.
ABSTRACT
Objective To evaluate the effects of prevention and control measures on coal-burning-borne endemic fluorosis in Shanxi Province, and to provide a scientific basis for further prevention and treatment of the disease. Methods In 2016, 7 diseased counties (cities) were selected in the whole province, three diseased townships were selected in each county(city), and five diseased villages were selected in each diseased township as the investigation sites. The investigation was carried out on the changes of improved stove and correct usage of the improved stove, and the correct drying behavior related to the corn and pepper for human consumption. Children aged 8 to 12 were examined dental fluorosis. In each village, 20 urine samples of 8 to 12 years old children were collected for fluorine determination. Urine fluoride was determined via the fluoride ion selective electrode method, and children dental fluorosis was diagnosed by "Diagnosis of Dental Fluorosis" method (WS/T 208-2011). Results Altogether 105 villages were investigated, including 31 696 households. The rates of the improved stove and the correct usage of the improved stove were 98.46%(31 209/31 696)and 98.80%(30 834/31 209);the correct drying rate related to the corn and pepper for human consumption was 99.97%(31 685/31 696);the dental fluorosis rate of 8 to 12 years old children,and the dental fluorosis index were 5.56%(264/4 751) and 0.13. The urine fluoride content was between 0.15 - 4.33 mg/L and the geometric mean value of fluoride content was 0.72 mg/L. Conclusions The prevention and control effect is obvious on coal-burning-borne endemic fluorosis in Shanxi Province. Disease surveillance,health education,the management and maintenance work of defluoridation stoves are keys in prevention of coal-burning-borne endemic fluorosis.
ABSTRACT
Objective To master the results of examination and evaluation of coal-burning-borne endemic fluorosis in Shanxi Province,and to provide a scientific basis for further prevention and treatment of the disease.Methods In 2012-2015,the prevention and control situation and condition survey were carried out in all coalburning-borne endemic fluorosis villages of 20 counties in Shanxi Province.A county-level self-inspection and a provincial-level spot-check were conducted to investigate the changes of improved stove and correct usage of the improved stove,and the correct drying of corn and pepper for human consumption.Children aged 8 to 12 were examined for dental fluorosis.The endemic areas were selected according to the Control Standards of Endemic Fluorosis in Endemic Areas (GB 17017-2010) and Eliminating Standards of Coal-burning Type Endemic Fluorosis,and dental fluorosis children was diagnosed based on the Diagnosis of Dental Fluorosis method (WS/T 208-2011).Results Totally 3 371 villages and 716 683 households were investigated,the rates of the improved stove and the correct usage of the improved stove were 98.72％ (707 502/716 683) and 98.74％ (698 608/707 502);the correct drying rate of corn and pepper for human consumption was 99.85％ (715 605/716 683);the dental fluorosis rate of 8 to 12 years old children and the dental fluorosis index were 6.41％ (6 762/105 453) and 0.14.A total of 20 counties in the province,9 counties had reached the control standards,11 counties had reached the elimination standards.Provincial and municipal level checked a total of 57 towns,157 villages,and the results of the overall compliance rate was 87.26％ (137/157).Conclusions The prevention and control effect is obvious on coalburning-borne endemic fluorosis in Shanxi Province.Disease surveillance,health education,the management and maintenance work on defluoridation stoves are keys in control of coal-burning-borne endemic fluorosis.