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Cited by 180Water Treatment and DisinfectionCarcinogens and Genotoxicity AssessmentArsenic contamination and mitigation

Meta-analysis of studies on individual consumption of chlorinated drinking water and bladder cancer

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Villanueva, C M, Fernández, F, Malats, N, Grimalt, J O, Kogevinas, M·2003·Journal of Epidemiology and Community Health
DOI 10.1136/jech.57.3.166PMC PMC1732410
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Abstract

Study objective: To evaluate whether consumption of chlorinated drinking water is associated with bladder cancer. Design: A bibliographic search was conducted and the authors selected studies evaluating individual consumption of chlorinated drinking water and bladder cancer. The authors extracted from each study risk estimates for intermediate and long term (>40 years) consumption of chlorinated water, stratified by sex when possible, and performed meta-analysis for the two exposure levels. A meta-analysis was also performed of the dose-response regression slopes. Setting: Populations in Europe and North America. Participants: Those included in six case-control studies (6084 incident bladder cancer cases, 10 816 controls) and two cohort studies (124 incident bladder cancer cases) fulfilling the inclusion criteria. Main results: Ever consumption of chlorinated drinking water was associated with an increased risk of bladder cancer in men (combined OR=1.4, 95%CI 1.1 to 1.9) and women (combined OR=1.2, 95%CI 0.7 to 1.8). The combined OR for mid-term exposure in both genders was 1.1 (95% CI 1.0 to 1.2) and for long term exposure was 1.4 (95%CI 1.2 to 1.7). The combined estimate of the slope for a linear increase in risk was 1.13 (95% CI 1.08 to 1.20) for 20 years and 1.27 (95% CI 1.15 to 1.43) for 40 years of exposure in both sexes. Conclusions: This meta-analysis of the best available epidemiological evidence indicates that long term consumption of chlorinated drinking water is associated with bladder cancer, particularly in men. The observed relative risk is only moderately high, but the population attributable risk could be important as the vast majority of the population of industrialised countries is potentially exposed to chlorination byproducts for long time periods.

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  • Villanueva et al. (2003) meta-analysis showed a combined relative risk of 1.6 (95% CI 1.2-2.2) in men and 1.4 (95% CI 0.6-3.6) in women for more than 40 years of exposure to chlorinated water.

    “A meta-analysis by Villanueva et al. (2003) of six case-control and two cohort studies showed a combined relative risk of 1.6 (95 % CI,1.2-2.2) in men and 1.4 (95 % CI 0.6-3.6) in women for more than 40 years of exposure to chlorinated water.”

    From Overview of Disinfection By-products and Associated Health Effects (2015) · cites this paper as Villanueva et al. (2003)

  • The bladder has been the most frequently evaluated cancer site, including two meta-analyses and two pooled analyses.

    “The bladder has been the most frequently evaluated cancer site, including two meta-analyses [49,50] and two pooled analyses [40, 51•].”

    From Overview of Disinfection By-products and Associated Health Effects (2015) · cites this paper as [50]

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Research works printed but not linked: 3

  1. [1]1. www.jech.com on July 15, 2023 by guest. Protected by copyright. http://jech.bmj.com/ J Epidemiol Community Health: first published as 10.1136/jech.57.3.166 on 1 March 2003. Downloaded from on July 15, 2023 by guest. Protected by copyright. http://jech.bmj.com/ J Epidemiol Community Health: first published as 10.1136/jech.57.3.166 on 1 March 2003. Downloaded from on July 15, 2023 by guest. Protected by copyright. http://jech.bmj.com/ J Epidemiol Community Health: first published as 10.1136/jech.57.3.166 on 1 March 2003. Downloaded from on July 15, 2023 by guest. Protected by copyright. http://jech.bmj.com/ J Epidemiol Community Health: first published as 10.1136/jech.57.3.166 on 1 March 2003. Downloaded from REFERENCES
  2. [17]17. Hsu LI, Chen CJ. Descriptive epidemiology, risk factors and genetic susceptibility of urinary bladder cancer. Chin J Public Health 1999;18:387-412.
  3. [23]23. Sharp S, Sterne J. sbe16: Meta-analysis. Stata Technical Bulletin 1997;38:9-14.

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Authors
Villanueva, C. M., Fernández, F., Malats, N., Grimalt, J. O., & Kogevinas, M.
Affiliations
  • Universitat Autònoma de Barcelona (ES)
  • Municipal Institute for Medical Research (ES)
  • Consejo Superior de Investigaciones Científicas (ES)
Corresponding author
Kogevinas, M
ORCID
Venue
Journal of Epidemiology and Community Health
Publisher
BMJ
Published
2003-03
Volume
57
Issue
3
Pages
166-173
ISSN
  • 0141-7681 (ISSN-L)
  • 0143-005X
  • 1470-2738
DOI
10.1136/jech.57.3.166
PMC
PMC1732410
OpenAlex
W2155742252
Semantic Scholar
3be8777c96dc85be3e2d1691a4b204361ab73e84
Cited by
180
References
47
Citations by year
2026: 1 · 2025: 9 · 2024: 10 · 2023: 4 · 2022: 10 · 2021: 9 · 2020: 9 · 2019: 6 · 2018: 10 · 2017: 3 · 2016: 9 · 2015: 15 · 2014: 3 · 2013: 7 · 2012: 7
FWCI
0.98
Type
journal article
Language
en
Open access
Locations
  • Journal of Epidemiology & Community Health (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • DIGITAL.CSIC (Spanish National Research Council (CSIC)) (submittedVersion)
Funders
Generalitat de Catalunya (00241, 1999SGR 0024 1)
Topics
  • Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Water Treatment and Disinfection
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Carcinogens and Genotoxicity Assessment
  • Physical Sciences › Environmental Science › Environmental Chemistry › Arsenic contamination and mitigation
Keywords
chlorinated drinking water, bladder cancer, chlorination by-products, long-term exposure, dose-response relationship, sex differences, cancer risk, population attributable risk
MeSH terms
Urinary Bladder Neoplasms, Chlorine, Environmental Exposure, Female, Humans, Male, Risk Factors, Time Factors, Water Supply, Odds Ratio, Sex Distribution, Water Purification, Risk Assessment

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