Journal Article Ppublish 8 citations
PubMed: 38330736 DOI: 10.1016/j.puhe.2024.01.001
Long-term cancer and overall mortality associated with drinking water nitrate in the United States.
Public Health 228:82-84
Authors: Angelico Mendy, Peter S Thorne
Affiliations
- Division of Epidemiology, Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
- Department of Occupational and Environmental Health, The University of Iowa College of Public Health, Iowa City, IA, USA.
Abstract
OBJECTIVES
Nitrate is a probable carcinogen regulated in drinking water by the US Environmental Protection Agency (EPA) to a maximum contaminant level (MCL) of 10Â mg/L nitrate-nitrogen (NO 3-N; equivalent to 44.3Â mg/L NO 3). We aimed to determine the association of US drinking water nitrate levels with overall as well as cardiovascular, cancer, and other cause mortality.
STUDY DESIGN
This study used a population-based retrospective cohort design.
METHODS
We analyzed data from 2029 participants of the 2005-2006 National Health and Nutrition Examination Survey followed for mortality until 2019 for a median of 13.9 years. We used Cox proportional hazards regression to estimate the hazard ratio (HR) and 95% confidence interval (CI) for mortality associated with drinking water nitrate, adjusting for covariates that included socio-economic factors and pack-years of cigarette smoking.
RESULTS
Drinking water nitrate was detected in 50.8Â % of the samples, had a median concentration of 0.77Â mg/L NO 3, and was above US EPA MCL in 0.4Â % of participants. In adjusted analysis, drinking water nitrate detection was associated with 73Â % higher cancer mortality (HR: 1.73, 95% CI: 1.19-2.51), whereas a 10-fold increase in drinking water nitrate levels was associated with 69Â % higher cancer mortality (HR: 1.69, 95% CI: 1.24-2.31) and 21Â % higher overall mortality (HR: 1.21, 95% CI: 1.00-1.46). Drinking water nitrate below EPA MCL was still associated with higher cancer mortality (HR: 1.61, 95% CI: 1.07-2.43 per 10-fold increase and HR: 1.61, 95% CI: 1.08-2.42 for detection).
CONCLUSIONS
Levels of drinking water nitrate may be an overlooked contributor to cancer mortality in the United States.
MeSH
Smoking, Mortality, Public Health, Nitrates, Neoplasms, Drinking Water
Cited by
- Association between perchlorate, nitrate, and thiocyanate exposure and kidney stones prevalence in US adults: an analysis based on the national health and nutrition examination survey 2007-2018. BMC Public Health, 2025
- Disinfection byproducts in US drinking water and cancer mortality. Int J Environ Health Res, 2025
- Epigenetic age acceleration and mortality risk prediction in U.S. adults. medRxiv, 2024