Vista Equipo: Ecological study on chronic kidney disease and arsenic in drinking water in districts of Guanacaste

Ecological study on chronic kidney disease and arsenic in drinking water in districts of Guanacaste

To analyze the association between arsenic-contaminated drinking water intake (total-As) above 10 ug/L and the Standardized Morbidity Index (SMI) for Chronic Kidney Disease (CKD) in the 59 districts of the province of Guanacaste, Costa Rica. 1600 sampling and analyses for total-As were performed on...

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Autores Principales:	Mora-Alvarado, Darner, Urbina-Campos, Azucena, Chamizo-García, Horacio
Formato:	Artículo
Idioma:	Español
Publicado:	Editorial Tecnológica de Costa Rica 2015
Materias:	Arsenic; water; ecological; Chronic Kidney Disease; morbidity. Arsénico; agua; ecológico; insuficiencia renal; morbilidad.
Acceso en línea:	https://revistas.tec.ac.cr/index.php/tec_marcha/article/view/2337 https://hdl.handle.net/2238/8823

id	RepoTEC8823
recordtype	dspace
spelling	RepoTEC88232018-09-20T21:20:23Z Ecological study on chronic kidney disease and arsenic in drinking water in districts of Guanacaste Estudio ecológico sobre insuficiencia renal crónica y arsénico en las aguas para consumo humano por distritos en Guanacaste Mora-Alvarado, Darner Urbina-Campos, Azucena Chamizo-García, Horacio Arsenic; water; ecological; Chronic Kidney Disease; morbidity. Arsénico; agua; ecológico; insuficiencia renal; morbilidad. To analyze the association between arsenic-contaminated drinking water intake (total-As) above 10 ug/L and the Standardized Morbidity Index (SMI) for Chronic Kidney Disease (CKD) in the 59 districts of the province of Guanacaste, Costa Rica. 1600 sampling and analyses for total-As were performed on water from 421 aqueducts and population weighted averages were calculated in each of the 59 districts. SMI were established using the CKD hospital discharge data for the year 2012. Using the above variables, and through a descriptive and retrospective-analytical methodology, an ecological study was designed, in which a linear correlation was tested, (95% confidence level), between the weighted averages (total-As, ug/L) and the SMI for the 59 districts. On the other hand a tendency analysis was performed with exposure intervals for each zone. In addition, a descriptive analysis was done for the 17 districts with a statistically significant SMI considering population weighed averages for As-total exposure. Total-As data show that among the 421 studied aqueducts, only 17 (4,00%) display concentrations above 10 ug/L, which are located in the districts of Cañas, Bebedero, Bagaces, and La Cruz. Results for SMI for CKD indicate that among the 59 districts, 33 (55,9%) had a SMI above “1,0”, in other words, the risk of disease por CKD was over the national average for the period of study. Statistical analyses indicate a simple correlation “r” of 0,41, which can be qualified as a medium-strength association between both variables, with a range of 0,33 and 0,66. Tendency analysis, according to the exposure intervals for As-total, show an irregular behavior within intervals 4 and 5, where the “medium-exposure” range, resulting from a weighted average between 11 and 20 ug/L, has a SMI for CKD higher than the “high-exposure” interval, which is higher than 20 ug/L total-As. In the descriptive analysis for the 17 districts with statistically significant SMI, some districts with a population-weighted average of total-As below 3 ug/L, but with a very high SMI for CKD, such as Nosara, Nacascolo, Diriá, Sámara, Palmira and Filadelfia. Conclusions: even though the tendency analysis shows there is an increased risk of illness as exposure augments up to the exposure range, individual comparison of the population-weighted averages for total-As and the SMI for CKD of the 17 districts; it is evident that some districts that were not exposed to total –As have a high SMI for CKD, such as Mansión, Sámara, Hojancha and Palmira. The same situation is also seen for the very low exposure category, such as Liberia, Nicoya, Nacascolo, Nosara, San Antonio, Santa Crur, 27 de Abril and Diriá. This suggests that total-As contaminated water, in the districts of Guanacaste, probably is not a common risk factor in the zones affected by the CKD epidemic. Recommendations: cross sectional and case/control studies should be done, without neglecting any hypothesis regarding the common risk factors in the CKD affected districts, including exposure to pesticides, high temperature, heavy metals (including total-As in drinking water) agrochemicals, agricultural occupation, among others. El objetivo del estudio fue analizar la asociación entre el consumo de agua contaminada con arsénico total (As-total) superior a 10 μg/L y los índices de morbilidad estandarizada (IME) de insuficiencia renal crónica (IRC) en los 59 distritos de los 11 cantones de la provincia de Guanacaste, Costa Rica. Para ello se realizaron al menos 1600 muestreos y análisis de As-total en las aguas de 421 acueductos, a los cuales se les calculó el promedio ponderado según su población; luego se establecieron los IME utilizando los egresos hospitalarios de personas con esta patología. Con estas variables se diseñó un estudio ecológico-retrospectivo con características descriptivas y analíticas, aplicando la correlación lineal al 95% de confianza entre los promedios ponderados de As-total (μg/L) y los IME de cada cantón. Por otro lado, se realizó un análisis de tendencia, utilizando intervalos de exposición a As-total y los IME ubicados en cada zona. Además, se elaboró un análisis descriptivo entre los 17 distritos con IME con significancia estadística y los promedios ponderados de As-total. Como resultados, los datos de As-total indican que de los 421 acueductos, solo 11 (2,6%) presentaron concentraciones superiores a 10 μg/L y pertenecen a los distritos de Cañas, Bebedero y Bagaces. Los resultados de IME de IRC indican que de los 59 distritos, 32 (54,2%) tenían un IME mayor a 1, es decir, el riesgo de enfermar por IRC era mayor al promedio nacional en el periodo 2003-2012. Los análisis estadísticos indican una correlación simple o r de 0,41, calificando la asociación entre ambas variables como Media, es decir, entre 0,33 y 0,66. El análisis de tendencias, según los intervalos o zonas de exposición a As-total, indican un comportamiento irregular en los intervalos 4 y 5, en donde la exposición “Medianamente Alta (11 a 20 μg/L de As-total) presenta un IME de IRC más alto que el intervalo Alta Exposición, o mayor a 20 μg/L de As-total. En el análisis descriptivo de los 17 distritos con IME con significancia estadística se observan varios distritos con promedios ponderados de As-total inferior a 3 μg/L pero con IME de IRC muy altos, como Nosara, Nacascolo, Diriá, Sámara, Palmira y Filadelfia. Conclusiones: la comparación individual de los 17 distritos de los promedios ponderados de As-total y los IME de IRC demuestran que existen distritos que no estuvieron expuestos a As-total, pero que presentan altos IME de IRC, como Mansión, Sámara, Hojancha y Palmira. Además, se presenta la misma situación en los distritos con Muy Baja Exposición, como Liberia, Nicoya, Nacascolo, Nosara, San Antonio, Santa Cruz, Veintisiete de Abril y Diriá. Esto sugiere que el agua contaminada con As-total en los distritos de Guanacaste probablemente no es un factor de riesgo común en las zonas afectadas por la epidemia de IRC. Recomendaciones: se debe continuar con otros estudios de tipo transversal o casos y controles, sin descartar ninguna hipótesis sobre factores de riesgo comunes en los distritos afectados con IRC, incluyendo la exposición a plaguicidas, altas temperaturas, metales pesados, incluido el As-total en aguas, y agroquímicos, entre otros. 2015-06-01 2017-09-19T20:37:49Z 2017-09-19T20:37:49Z info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion Artículo revisado por pares https://revistas.tec.ac.cr/index.php/tec_marcha/article/view/2337 10.18845/tm.v28i2.2337 https://hdl.handle.net/2238/8823 spa https://revistas.tec.ac.cr/index.php/tec_marcha/article/view/2337/2126 Copyright (c) 2015 Tecnología en Marcha application/pdf Editorial Tecnológica de Costa Rica Revista Tecnología en Marcha; Vol. 28, Núm. 2: Abril-Junio 2015; pág. 102-115 2215-3241 0379-3982
institution	Tecnológico de Costa Rica
collection	Repositorio TEC
language	Español
topic	Arsenic; water; ecological; Chronic Kidney Disease; morbidity. Arsénico; agua; ecológico; insuficiencia renal; morbilidad.
spellingShingle	Arsenic; water; ecological; Chronic Kidney Disease; morbidity. Arsénico; agua; ecológico; insuficiencia renal; morbilidad. Mora-Alvarado, Darner Urbina-Campos, Azucena Chamizo-García, Horacio Ecological study on chronic kidney disease and arsenic in drinking water in districts of Guanacaste
description	To analyze the association between arsenic-contaminated drinking water intake (total-As) above 10 ug/L and the Standardized Morbidity Index (SMI) for Chronic Kidney Disease (CKD) in the 59 districts of the province of Guanacaste, Costa Rica. 1600 sampling and analyses for total-As were performed on water from 421 aqueducts and population weighted averages were calculated in each of the 59 districts. SMI were established using the CKD hospital discharge data for the year 2012. Using the above variables, and through a descriptive and retrospective-analytical methodology, an ecological study was designed, in which a linear correlation was tested, (95% confidence level), between the weighted averages (total-As, ug/L) and the SMI for the 59 districts. On the other hand a tendency analysis was performed with exposure intervals for each zone. In addition, a descriptive analysis was done for the 17 districts with a statistically significant SMI considering population weighed averages for As-total exposure. Total-As data show that among the 421 studied aqueducts, only 17 (4,00%) display concentrations above 10 ug/L, which are located in the districts of Cañas, Bebedero, Bagaces, and La Cruz. Results for SMI for CKD indicate that among the 59 districts, 33 (55,9%) had a SMI above “1,0”, in other words, the risk of disease por CKD was over the national average for the period of study. Statistical analyses indicate a simple correlation “r” of 0,41, which can be qualified as a medium-strength association between both variables, with a range of 0,33 and 0,66. Tendency analysis, according to the exposure intervals for As-total, show an irregular behavior within intervals 4 and 5, where the “medium-exposure” range, resulting from a weighted average between 11 and 20 ug/L, has a SMI for CKD higher than the “high-exposure” interval, which is higher than 20 ug/L total-As. In the descriptive analysis for the 17 districts with statistically significant SMI, some districts with a population-weighted average of total-As below 3 ug/L, but with a very high SMI for CKD, such as Nosara, Nacascolo, Diriá, Sámara, Palmira and Filadelfia. Conclusions: even though the tendency analysis shows there is an increased risk of illness as exposure augments up to the exposure range, individual comparison of the population-weighted averages for total-As and the SMI for CKD of the 17 districts; it is evident that some districts that were not exposed to total –As have a high SMI for CKD, such as Mansión, Sámara, Hojancha and Palmira. The same situation is also seen for the very low exposure category, such as Liberia, Nicoya, Nacascolo, Nosara, San Antonio, Santa Crur, 27 de Abril and Diriá. This suggests that total-As contaminated water, in the districts of Guanacaste, probably is not a common risk factor in the zones affected by the CKD epidemic. Recommendations: cross sectional and case/control studies should be done, without neglecting any hypothesis regarding the common risk factors in the CKD affected districts, including exposure to pesticides, high temperature, heavy metals (including total-As in drinking water) agrochemicals, agricultural occupation, among others.
format	Artículo
author	Mora-Alvarado, Darner Urbina-Campos, Azucena Chamizo-García, Horacio
author_sort	Mora-Alvarado, Darner
title	Ecological study on chronic kidney disease and arsenic in drinking water in districts of Guanacaste
title_short	Ecological study on chronic kidney disease and arsenic in drinking water in districts of Guanacaste
title_full	Ecological study on chronic kidney disease and arsenic in drinking water in districts of Guanacaste
title_fullStr	Ecological study on chronic kidney disease and arsenic in drinking water in districts of Guanacaste
title_full_unstemmed	Ecological study on chronic kidney disease and arsenic in drinking water in districts of Guanacaste
title_sort	ecological study on chronic kidney disease and arsenic in drinking water in districts of guanacaste
publisher	Editorial Tecnológica de Costa Rica
publishDate	2015
url	https://revistas.tec.ac.cr/index.php/tec_marcha/article/view/2337 https://hdl.handle.net/2238/8823
_version_	1796141466200834048
score	12.043409

Ecological study on chronic kidney disease and arsenic in drinking water in districts of Guanacaste

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