An ecologic study of nitrate in municipal drinking water and cancer incidence in Trnava District, Slovakia

Gabriel Gulis, Monika Czompolyova, James R Cerhan

Research output: Contribution to journalArticle

147 Citations (Scopus)

Abstract

Contamination of drinking water by nitrate is an evolving public health concern since nitrate can undergo endogenous reduction to nitrite, and nitrosation of nitrites can form N-nitroso compounds, which are potent carcinogens. We conducted an ecologic study to determine whether nitrate levels in drinking water were correlated with non-Hodgkin lymphoma and cancers of the digestive and urinary tracts in an agricultural district (Trnava District; population 237,000) of the Slovak Republic. Routinely collected nitrate data (1975-1995) for villages using public water supplies were computerized, and each village was categorized into low (0-10mg/L), medium (10.1-20mg/L), or high (20.1-50 mg/L) average levels of total nitrate in drinking water. Observed cases of cancer in each of these villages were ascertained through the district cancer registry for the time period 1986-1995. Standardized incidence ratios (SIRs) and 95% confidence intervals (CI) for all cancer and selected cancer sites were calculated by indirect standardization using age- and sex-specific incidence rates from the entire district. For all cancer in women, SIRs increased from villages with low (SIR=0.87; 95% CI 0.72-0.95) to medium (SIR=1.07; 95% CI 1.00-1.13) to high (SIR=1.14; 1.06-1.22) levels of nitrate (P for trend < 0.001); there was a similar trend for all cancer in men from low (SIR=0.90; 95% CI 0.810.99) to medium (SIR=I.08, 95% CI 1.02-1.16), but not for high (SIR=0.94; 0.88-1.02), nitrate levels (P for trend < 0.001). This pattern in the SIRs (from low to high nitrate level) was also seen for stomach cancer in women (0.81, 0.94, 1.24; P for trend=0.10), colorectal cancer in women (0.64, 1.11, 1.29; P for trend <0.001) and men (0.77, 0.99, 1.07; P for trend=0.051), and non-Hodgkin lymphoma in women (0.45, 0.90, 1.35; P for trend=0.13) and men (0.25, 1.66, and 1.09; P for trend=0.017). There were no associations for kidney or bladder cancer. These ecologic data support the hypothesis that there is a positive association between nitrate in drinking water and non-Hodgkin lymphoma and colorectal cancer.

Original languageEnglish (US)
Pages (from-to)182-187
Number of pages6
JournalEnvironmental Research
Volume88
Issue number3
DOIs
StatePublished - 2002
Externally publishedYes

Fingerprint

Slovakia
Drinking Water
Nitrates
cancer
drinking water
nitrate
Incidence
confidence interval
Neoplasms
Confidence Intervals
village
Non-Hodgkin's Lymphoma
Nitrites
Colorectal Neoplasms
nitrite
Nitroso Compounds
Nitrosation
Urologic Neoplasms
Public health
Water Supply

Keywords

  • Drinking water
  • Ecologic studies
  • Neoplasms
  • Nitrate
  • Slovakia

ASJC Scopus subject areas

  • Environmental Science(all)

Cite this

An ecologic study of nitrate in municipal drinking water and cancer incidence in Trnava District, Slovakia. / Gulis, Gabriel; Czompolyova, Monika; Cerhan, James R.

In: Environmental Research, Vol. 88, No. 3, 2002, p. 182-187.

Research output: Contribution to journalArticle

@article{ddd3b4ed0f624087b25ee52b8f0f7704,
title = "An ecologic study of nitrate in municipal drinking water and cancer incidence in Trnava District, Slovakia",
abstract = "Contamination of drinking water by nitrate is an evolving public health concern since nitrate can undergo endogenous reduction to nitrite, and nitrosation of nitrites can form N-nitroso compounds, which are potent carcinogens. We conducted an ecologic study to determine whether nitrate levels in drinking water were correlated with non-Hodgkin lymphoma and cancers of the digestive and urinary tracts in an agricultural district (Trnava District; population 237,000) of the Slovak Republic. Routinely collected nitrate data (1975-1995) for villages using public water supplies were computerized, and each village was categorized into low (0-10mg/L), medium (10.1-20mg/L), or high (20.1-50 mg/L) average levels of total nitrate in drinking water. Observed cases of cancer in each of these villages were ascertained through the district cancer registry for the time period 1986-1995. Standardized incidence ratios (SIRs) and 95{\%} confidence intervals (CI) for all cancer and selected cancer sites were calculated by indirect standardization using age- and sex-specific incidence rates from the entire district. For all cancer in women, SIRs increased from villages with low (SIR=0.87; 95{\%} CI 0.72-0.95) to medium (SIR=1.07; 95{\%} CI 1.00-1.13) to high (SIR=1.14; 1.06-1.22) levels of nitrate (P for trend < 0.001); there was a similar trend for all cancer in men from low (SIR=0.90; 95{\%} CI 0.810.99) to medium (SIR=I.08, 95{\%} CI 1.02-1.16), but not for high (SIR=0.94; 0.88-1.02), nitrate levels (P for trend < 0.001). This pattern in the SIRs (from low to high nitrate level) was also seen for stomach cancer in women (0.81, 0.94, 1.24; P for trend=0.10), colorectal cancer in women (0.64, 1.11, 1.29; P for trend <0.001) and men (0.77, 0.99, 1.07; P for trend=0.051), and non-Hodgkin lymphoma in women (0.45, 0.90, 1.35; P for trend=0.13) and men (0.25, 1.66, and 1.09; P for trend=0.017). There were no associations for kidney or bladder cancer. These ecologic data support the hypothesis that there is a positive association between nitrate in drinking water and non-Hodgkin lymphoma and colorectal cancer.",
keywords = "Drinking water, Ecologic studies, Neoplasms, Nitrate, Slovakia",
author = "Gabriel Gulis and Monika Czompolyova and Cerhan, {James R}",
year = "2002",
doi = "10.1006/enrs.2002.4331",
language = "English (US)",
volume = "88",
pages = "182--187",
journal = "Environmental Research",
issn = "0013-9351",
publisher = "Academic Press Inc.",
number = "3",

}

TY - JOUR

T1 - An ecologic study of nitrate in municipal drinking water and cancer incidence in Trnava District, Slovakia

AU - Gulis, Gabriel

AU - Czompolyova, Monika

AU - Cerhan, James R

PY - 2002

Y1 - 2002

N2 - Contamination of drinking water by nitrate is an evolving public health concern since nitrate can undergo endogenous reduction to nitrite, and nitrosation of nitrites can form N-nitroso compounds, which are potent carcinogens. We conducted an ecologic study to determine whether nitrate levels in drinking water were correlated with non-Hodgkin lymphoma and cancers of the digestive and urinary tracts in an agricultural district (Trnava District; population 237,000) of the Slovak Republic. Routinely collected nitrate data (1975-1995) for villages using public water supplies were computerized, and each village was categorized into low (0-10mg/L), medium (10.1-20mg/L), or high (20.1-50 mg/L) average levels of total nitrate in drinking water. Observed cases of cancer in each of these villages were ascertained through the district cancer registry for the time period 1986-1995. Standardized incidence ratios (SIRs) and 95% confidence intervals (CI) for all cancer and selected cancer sites were calculated by indirect standardization using age- and sex-specific incidence rates from the entire district. For all cancer in women, SIRs increased from villages with low (SIR=0.87; 95% CI 0.72-0.95) to medium (SIR=1.07; 95% CI 1.00-1.13) to high (SIR=1.14; 1.06-1.22) levels of nitrate (P for trend < 0.001); there was a similar trend for all cancer in men from low (SIR=0.90; 95% CI 0.810.99) to medium (SIR=I.08, 95% CI 1.02-1.16), but not for high (SIR=0.94; 0.88-1.02), nitrate levels (P for trend < 0.001). This pattern in the SIRs (from low to high nitrate level) was also seen for stomach cancer in women (0.81, 0.94, 1.24; P for trend=0.10), colorectal cancer in women (0.64, 1.11, 1.29; P for trend <0.001) and men (0.77, 0.99, 1.07; P for trend=0.051), and non-Hodgkin lymphoma in women (0.45, 0.90, 1.35; P for trend=0.13) and men (0.25, 1.66, and 1.09; P for trend=0.017). There were no associations for kidney or bladder cancer. These ecologic data support the hypothesis that there is a positive association between nitrate in drinking water and non-Hodgkin lymphoma and colorectal cancer.

AB - Contamination of drinking water by nitrate is an evolving public health concern since nitrate can undergo endogenous reduction to nitrite, and nitrosation of nitrites can form N-nitroso compounds, which are potent carcinogens. We conducted an ecologic study to determine whether nitrate levels in drinking water were correlated with non-Hodgkin lymphoma and cancers of the digestive and urinary tracts in an agricultural district (Trnava District; population 237,000) of the Slovak Republic. Routinely collected nitrate data (1975-1995) for villages using public water supplies were computerized, and each village was categorized into low (0-10mg/L), medium (10.1-20mg/L), or high (20.1-50 mg/L) average levels of total nitrate in drinking water. Observed cases of cancer in each of these villages were ascertained through the district cancer registry for the time period 1986-1995. Standardized incidence ratios (SIRs) and 95% confidence intervals (CI) for all cancer and selected cancer sites were calculated by indirect standardization using age- and sex-specific incidence rates from the entire district. For all cancer in women, SIRs increased from villages with low (SIR=0.87; 95% CI 0.72-0.95) to medium (SIR=1.07; 95% CI 1.00-1.13) to high (SIR=1.14; 1.06-1.22) levels of nitrate (P for trend < 0.001); there was a similar trend for all cancer in men from low (SIR=0.90; 95% CI 0.810.99) to medium (SIR=I.08, 95% CI 1.02-1.16), but not for high (SIR=0.94; 0.88-1.02), nitrate levels (P for trend < 0.001). This pattern in the SIRs (from low to high nitrate level) was also seen for stomach cancer in women (0.81, 0.94, 1.24; P for trend=0.10), colorectal cancer in women (0.64, 1.11, 1.29; P for trend <0.001) and men (0.77, 0.99, 1.07; P for trend=0.051), and non-Hodgkin lymphoma in women (0.45, 0.90, 1.35; P for trend=0.13) and men (0.25, 1.66, and 1.09; P for trend=0.017). There were no associations for kidney or bladder cancer. These ecologic data support the hypothesis that there is a positive association between nitrate in drinking water and non-Hodgkin lymphoma and colorectal cancer.

KW - Drinking water

KW - Ecologic studies

KW - Neoplasms

KW - Nitrate

KW - Slovakia

UR - http://www.scopus.com/inward/record.url?scp=0036246645&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0036246645&partnerID=8YFLogxK

U2 - 10.1006/enrs.2002.4331

DO - 10.1006/enrs.2002.4331

M3 - Article

VL - 88

SP - 182

EP - 187

JO - Environmental Research

JF - Environmental Research

SN - 0013-9351

IS - 3

ER -