Progress in the prevention and control of water-borne arsenicosis in China.

In this report, we provided an overview of the prevalence, control, and prevention of water-borne arsenicosis in China during 2001-2016. Random sampling was continuously performed during 2001-2010 to find villages having high levels of arsenic (>50 µg/L) in drinking water. The high-arsenic-exposure villages with more geographically dispersed water supplies were subsequently analyzed for characteristics of arsenic distribution, and villages with relatively large populations were investigated for arsenicosis. The results showed that among 32,673,677 inhabitants in 36,820 villages, 1,894,587 inhabitants in 2,476 villages were at risk of high arsenic exposure. Among the 33,318 drinking water sources surveyed in 625 high-arsenic-exposure villages, 9,807 drinking water sources that contained high levels of arsenic (>50 µg/L) were identified. The overall prevalence rate of arsenicosis was 1.93%. Further, some representative villages were chosen to monitor arsenicosis annually, showing that the prevalence rate of arsenicosis was lower in villages with arsenic-safe water supplies than in villages without arsenic-safe water supplies. To the best of our knowledge, this report provides the most comprehensive assessment of the distribution of high arsenic exposure and arsenicosis in China until now.

A national cross-sectional study on effects of fluoride-safe water supply on the prevalence of fluorosis in China.

OBJECTIVE: To assess the effects of provided fluoride-safe drinking-water for the prevention and control of endemic fluorosis in China. DESIGN: A national cross-sectional study in China. SETTING: In 1985, randomly selected villages in 27 provinces (or cities and municipalities) in 5 geographic areas all over China. PARTICIPANTS: Involved 81 786 children aged from 8 to 12 and 594 698 adults aged over 16. MAIN OUTCOME MEASURE: The prevalence of dental fluorosis and clinical skeletal fluorosis, the fluoride concentrations in the drinking-water in study villages and in the urine of subjects. RESULTS: The study showed that in the villages where the drinking-water fluoride concentrations were higher than the government standard of 1.2 mg/l, but no fluoride-safe drinking-water supply scheme was provided (FNB areas), the prevalence rate and index of dental fluorosis in children, and prevalence rate of clinical skeletal fluorosis in adults were all significantly higher than those in the historical endemic fluorosis villages after the fluoride-safe drinking-water were provided (FSB areas). Additionally, the prevalence rate of dental fluorosis as well as clinical skeletal fluorosis, and the concentration of fluoride in urine were found increased with the increase of fluoride concentration in drinking-water, with significant positive correlations in the FNB areas. While, the prevalence rate of dental fluorosis and clinical skeletal fluorosis in different age groups and their degrees of prevalence were significantly lower in the FSB areas than those in the FNB areas. CONCLUSIONS: The provision of fluoride-safe drinking-water supply schemes had significant effects on the prevention and control of dental fluorosis and skeletal fluorosis. The study also indicated that the dental and skeletal fluorosis is still prevailing in the high-fluoride drinking-water areas in China.

Health effects of exposure to natural arsenic in groundwater and coal in China: an overview of occurrence.

Between 2001 and 2005, 21,155 of 445,638 wells in 20,517 villages in 292 counties in 16 provinces from China, or 5% of wells, were found to contain > 50 microg/L arsenic (As) by field testing with the Merck As kit. We achieved quality assurance of analysis of at least 10% of the wells containing > 50 microg/L As using hydride generation atomic fluorescence spectrometry and silver dithiodicarbomate spectrometry. Our best estimate of the population exposed to > 50 microg/L As in drinking water was 582,769. This is probably an underestimate for China because of the limited area surveyed. In a survey of 135,492 individuals in eight provinces, we used the National Diagnosis Standard for Endemic Arsenicosis and identified 10,096 cases of arsenicosis with various degrees of skin lesions. The arsenicosis occurrence rate of 7.5% is likely an overestimate, because the survey focused more on known and suspected endemic areas of arsenicosis. The occurrence of arsenicosis correlates positively with the percentage of wells containing > 50 microg/L As, or at a ratio of 1 to 5%. Based on both the amount of As in well water and the rate of occurrence of arsenicosis, Shanxi province, Inner Mongolia autonomous region, and Jilin province are the top three areas in China as of 2005 for exposure to endemic As from drinking water. Our survey also identified exposure to high levels of As from wells in several provinces and from the indoor burning of coal containing high levels of As in Shaanxi province. These areas, however, have not had any reports of previous arsenicosis endemics. In the endemic areas, the average rate of occurrence of arsenicosis at advanced stages was 1.2%, possibly because of a long exposure time of > 20 years; the rate of occurrence increased to 2.7% when we included a high dose of As exposure from the indoor burning of coal. Mitigation to reduce As exposure remains a challenge in rural China.

Relationship between fluorine in drinking water and dental health of residents in some large cities in China.

In this project, the relationship between fluorine content in drinking water and dental health of residents in some large cities in China was evaluated. The concentration of fluorine in tap water and in urine of local subjects of 28 cities and 4 high fluorine villages in China shows a strong positive correlation (r(2)=0.96, S.E.=0.9881). Our studies indicate that drinking water is the most important source of fluorine intake for Chinese people, and in more than 90% of urban cities, fluorine concentrations in drinking water are below levels recommended by the WHO (approximately 0.5-1.0 mg/l). A 1995 investigation by The National Committee on Oral Health of China (NCOH) shows the relationship between average number of decayed, missing and filled teeth (DMFT) of urban residents and fluorine concentration in drinking water to be negatively correlated but not forming a good linear relationship. Our results, together with the previous study, suggest that: (1) dental caries of the study population can be reduced by drinking water fluoridation and that (2) other factors such as economic level, weather, lifestyle, food habits, living condition, etc., of a city can also affect the incidence of dental caries that cannot be predicted by fluoridation alone. Research on the relation between index of fluorosis (IF) and the fluorine concentration in drinking water for the four high fluorine villages showed that the recommended concentration of fluorine in drinking water can protect from dental fluorosis.