1. Ktisis Cyprus University of Technology
  2. Cyprus University of Technology (Research Output)
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Please use this identifier to cite or link to this item: https://hdl.handle.net/20.500.14279/19443
DC FieldValueLanguage
dc.contributor.authorEvlampidou, Iro-
dc.contributor.authorFont-Ribera, Laia-
dc.contributor.authorRojas-Rueda, David-
dc.contributor.authorGracia-Lavedan, Esther-
dc.contributor.authorCostet, Nathalie-
dc.contributor.authorPearce, Neil-
dc.contributor.authorVineis, Paolo-
dc.contributor.authorJaakkola, J. J.K.-
dc.contributor.authorDelloye, Francis-
dc.contributor.authorMakris, Konstantinos C.-
dc.contributor.authorStephanou, Euripides G.-
dc.contributor.authorKargaki, Sophia-
dc.contributor.authorKožíšek, František-
dc.contributor.authorSigsgaard, Torben-
dc.contributor.authorHansen, Birgitte-
dc.contributor.authorSchullehner, Jörg-
dc.contributor.authorNahkur, Ramon-
dc.contributor.authorGaley, Catherine-
dc.contributor.authorZwiener, Christian-
dc.contributor.authorVargha, Márta-
dc.contributor.authorRighi, Elena-
dc.contributor.authorAggazzotti, Gabriella-
dc.contributor.authorKalnina, Gunda-
dc.contributor.authorGražulevičieně, Regina-
dc.contributor.authorPolańska, Kinga-
dc.contributor.authorGubkova, Dasa-
dc.date.accessioned2020-11-19T11:40:15Z-
dc.date.available2020-11-19T11:40:15Z-
dc.date.issued2020-01-
dc.identifier.citationEnvironmental Health Perspectives, 2020, vol. 128, no. 1, articl. no. 017001en_US
dc.identifier.issn15529924-
dc.identifier.urihttps://hdl.handle.net/20.500.14279/19443-
dc.description.sponsorshipBACKGROUND: Trihalomethanes (THMs) are widespread disinfection by-products (DBPs) in drinking water, and long-term exposure has been consistently associated with increased bladder cancer risk. OBJECTIVE: We assessed THM levels in drinking water in the European Union as a marker of DBP exposure and estimated the attributable burden of bladder cancer. METHODS: We collected recent annual mean THM levels in municipal drinking water in 28 European countries (EU28) from routine monitoring records. We estimated a linear exposure–response function for average residential THM levels and bladder cancer by pooling data from studies included in the largest international pooled analysis published to date in order to estimate odds ratios (ORs) for bladder cancer associated with the mean THM level in each country (relative to no exposure), population-attributable fraction (PAF), and number of attributable bladder cancer cases in different scenarios using incidence rates and population from the Global Burden of Disease study of 2016. RESULTS: We obtained 2005–2018 THM data from EU26, covering 75% of the population. Data coverage and accuracy were heterogeneous among countries. The estimated population-weighted mean THM level was 11:7 μg/L [standard deviation (SD) of 11.2]. The estimated bladder cancer PAF was 4.9% [95% confidence interval (CI): 2.5, 7.1] overall (range: 0–23%), accounting for 6,561 (95% CI: 3,389, 9,537) bladder cancer cases per year. Denmark and the Netherlands had the lowest PAF (0.0% each), while Cyprus (23.2%), Malta (17.9%), and Ireland (17.2%) had the highest among EU26. In the scenario where no country would exceed the current EU mean, 2,868 (95% CI: 1,522, 4,060; 43%) annual attributable bladder cancer cases could potentially be avoided. DISCUSSION: Efforts have been made to reduce THM levels in the European Union. However, assuming a causal association, current levels in certain countries still could lead to a considerable burden of bladder cancer that could potentially be avoided by optimizing water treatment, disinfection, and distribution practices, among other possible measures.en_US
dc.formatpdfen_US
dc.language.isoenen_US
dc.relation.ispartofEnvironmental Health Perspectivesen_US
dc.rightsAttribution-NonCommercial-NoDerivatives 4.0 Internationalen_US
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/*
dc.subjectChlorineen_US
dc.subjectChlorine dioxideen_US
dc.subjectDrinking wateren_US
dc.subjectHypochloriteen_US
dc.subjectTrihalomethaneen_US
dc.subjectDrinking wateren_US
dc.titleTrihalomethanes in drinking water and bladder cancer burden in the European Unionen_US
dc.typeArticleen_US
dc.collaborationISGlobalen_US
dc.collaborationUniversitat Pompeu Fabraen_US
dc.collaborationCIBER Epidemiología y Salud Pública (CIBERESP)en_US
dc.collaborationHospital Del Mar Research Institute (IMIM)en_US
dc.collaborationUniversité de Rennesen_US
dc.collaborationLondon School of Hygiene and Tropical Medicineen_US
dc.collaborationImperial College Londonen_US
dc.collaborationUniversity of Ouluen_US
dc.collaborationService Public de Wallonieen_US
dc.collaborationCyprus University of Technologyen_US
dc.collaborationUniversity of Creteen_US
dc.collaborationThe Cyprus Instituteen_US
dc.collaborationNational Institute of Public Health Pragueen_US
dc.collaborationAarhus Universityen_US
dc.collaborationGeological Survey of Denmark and Greenlanden_US
dc.collaborationEstonian Ministry of Social Affairsen_US
dc.collaborationSanté Publique Franceen_US
dc.collaborationEberhard Karls University Tübingenen_US
dc.collaborationNational Public Health Instituteen_US
dc.collaborationUniversity of Modena and Reggio Emiliaen_US
dc.collaborationMinistry of Health of the Republic Latviaen_US
dc.collaborationVytautas Magnus Universityen_US
dc.collaborationNofer Institute of Occupational Medicine in Łódźen_US
dc.collaborationPublic Health Authority of the Slovak Republicen_US
dc.collaborationNational Institute of Public Health Ljubljanaen_US
dc.collaborationCranfield Universityen_US
dc.subject.categoryHealth Sciencesen_US
dc.journalsOpen Accessen_US
dc.countrySpainen_US
dc.countryFranceen_US
dc.countryUnited Kingdomen_US
dc.countryFinlanden_US
dc.countryBelgiumen_US
dc.countryCyprusen_US
dc.countryGreeceen_US
dc.countryCzech Republicen_US
dc.countryDenmarken_US
dc.countryEstoniaen_US
dc.countryGermanyen_US
dc.countryHungaryen_US
dc.countryItalyen_US
dc.countryLatviaen_US
dc.countryLithuaniaen_US
dc.countryPolanden_US
dc.countrySlovakiaen_US
dc.countrySloveniaen_US
dc.subject.fieldMedical and Health Sciencesen_US
dc.publicationPeer Revieweden_US
dc.identifier.doi10.1289/EHP4495en_US
dc.relation.issue1en_US
dc.relation.volume128en_US
cut.common.academicyear2019-2020en_US
item.openairecristypehttp://purl.org/coar/resource_type/c_6501-
item.openairetypearticle-
item.cerifentitytypePublications-
item.grantfulltextopen-
item.languageiso639-1en-
item.fulltextWith Fulltext-
crisitem.journal.journalissn1552-9924-
crisitem.journal.publisherUS Department of Health and Human Services-
crisitem.author.deptDepartment of Rehabilitation Sciences-
crisitem.author.facultyFaculty of Health Sciences-
crisitem.author.orcid0000-0001-5251-8619-
crisitem.author.parentorgFaculty of Health Sciences-
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