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Association between gastric cancer mortality and nitrate content of drinking water: Ecological study on small area inequalities

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Abstract

The carcinogenic feature of N-nitroso compounds has been well established. Similarly, the transformation of ingested nitrate to N-nitroso compounds in the stomach has been thoroughly documented, nevertheless nitrates' carcinogenic effect has not been proved convincingly in human. The present study was aimed to investigate a population of small villages provided by drinking water with high and widely variable nitrate content (72 mg/l median, 290.7 mg/l 95-percentile concentration). Empirical Bayes estimates for settlement-specific age-, sex-, and year-standardised mortality ratios of gastric cancer (GC) were related to the settlement level average nitrate concentrations in drinking water controlling for confounding effects of smoking, ethnicity and education. The log-transformed average nitrate concentration showed significant positive association with stomach cancer mortality in linear regression analysis (p = 0.014). The settlements were aggregated according to the nitrate concentration into 10-percentile groups and the standardised mortality ratios (SMRs) were calculated. Those groups with higher than 88 mg/l average nitrate concentration showed substantial risk elevation and the log-transformed exposure variables proved to be significant predictors of mortality (p equals; 0.032) at this level of aggregation also. The association seemed to be fairly strong (r 2 equals; 0.46). Although this investigation constituting an ecological study has certain limitations, it supports the hypothesis that the high level of nitrate in drinking water is involved in the development of GC.

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Authors and Affiliations

  1. Department of Public Health, University of Pecs, Pecs, Hungary

    Janos Sandor, Istvan Kiss, Orsolya Farkas & Istvan Ember

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  1. Janos Sandor
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  2. Istvan Kiss
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  3. Orsolya Farkas
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  4. Istvan Ember
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Sandor, J., Kiss, I., Farkas, O. et al. Association between gastric cancer mortality and nitrate content of drinking water: Ecological study on small area inequalities. Eur J Epidemiol 17, 443–447 (2001). https://doi.org/10.1023/A:1013765016742

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