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标题：Bladder Cancer and Water Disinfection By-product Exposures through Multiple Routes: A Population-Based Case–Control Study (New England, USA)
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作者：Laura E. Beane Freeman ; Kenneth P. Cantor ; Dalsu Baris 等
期刊名称：Environmental Health Perspectives
印刷版ISSN：0091-6765
电子版ISSN：1552-9924
出版年度：2017
卷号：125
期号：6
页码：067010
DOI：10.1289/EHP89
语种：English
出版社：OCR Subscription Services Inc
摘要：Background: Ingestion of disinfection byproducts has been associated with bladder cancer in multiple studies. Although associations with other routes of exposure have been suggested, epidemiologic evidence is limited. Objectives: We evaluated the relationship between bladder cancer and total, chlorinated, and brominated trihalomethanes (THMs) through various exposure routes. Methods: In a population-based case–control study in New England ( n = 1,213 cases; n = 1,418 controls), we estimated lifetime exposure to THMs from ingestion, showering/bathing, and hours of swimming pool use. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) using unconditional logistic regression adjusted for confounders. Results: Adjusted ORs for bladder cancer comparing participants with exposure above the 95th percentile with those in the lowest quartile of exposure (based on the distribution in controls) were statistically significant for average daily intake mg/d of total THMs [OR = 1.53 (95% CI: 1.01, 2.32), p - trend = 0.16] and brominated THMs [OR = 1.98 (95% CI: 1.19, 3.29), p - trend = 0.03]. For cumulative intake mg, the OR at the 95th percentile of total THMs was 1.45 (95% CI: 0.95, 2.2), p - trend = 0.13; the ORs at the 95th percentile for chlorinated and brominated THMs were 1.77 (95% CI: 1.05, 2,.99), p - trend = 0.07 and 1.78 (95% CI: 1.05, 3.00), p - trend = 0.02, respectively. The OR in the highest category of showering/bathing for brominated THMs was 1.43 (95% CI: 0.80, 2.42), p - trend = 0.10. We found no evidence of an association for bladder cancer and hours of swimming pool use. Conclusions: We observed a modest association between ingestion of water with higher THMs ( > 95th percentile vs. < 25th percentile) and bladder cancer. Brominated THMs have been a particular concern based on toxicologic evidence, and our suggestive findings for multiple metrics require further study in a population with higher levels of these exposures. Data from this population do not support an association between swimming pool use and bladder cancer. https://doi.org/10.1289/EHP89