Page 96 - JCTR-11-3

Journal of Clinical and
Translational Research Household arsenic and bladder cancer

Questions covered tobacco smoking, type of neighborhood Table 1. Demographic characteristics of patients with
(urban/suburban/rural), degree of drive-by automobile urothelial cell carcinoma and control patients with benign
traffic, frequency of home herbicide and insecticide use, urologic disease
primary drinking water sources, and the presence of a Characteristic UCC patients Benign
treated lumber deck, swimming pool, or wood-burning n=25 controls n=25
fireplace. Each questionnaire was assigned a unique Age range
household study ID to protect patient confidentiality.
41 – 50 1 2
2.4. Area deprivation and urbanicity 51 – 60 0 2
We used the area deprivation index (ADI) as an indicator of 61 – 70 10 6
socioeconomic status for each patient. The ADI incorporates 71 – 80 13 14
aggregate income, education, employment, and housing 81+ 1 1
quality by census block. The online Neighborhood Atlas Sex
®
22
tool was used to map home addresses to ADI scores by Male 19 20
23
national percentiles. A higher ADI and larger national Female 6 5
percentiles indicate greater poverty and deprivation based
on income, education, employment, and housing quality. Race
Compiled data from the Neighborhood Atlas were available Caucasian 23 24
from 2017 to 2021. To assess urbanicity, we assigned the No response 2 1
United States Department of Agriculture Rural-Urban Ethnicity
Continuum Codes (RUCC) based on each patient’s Non-Hispanic 23 20
home address. For this system, codes 1 – 3 correspond to Hispanic 0 1
metropolitan (urban) areas and codes 4 – 9 correspond to No response 2 4
increasingly rural areas. The United States Department of Highest educational level
24
Agriculture RUCC data were available for 2023. 25
Post-college 2 13*
2.5. Statistical analyses Four-year college 8 2

Questionnaire data were encoded as categorical outcomes Some college 7 6
and compared between cases and controls using Chi- High school 6 3
square or Fisher’s exact tests, with odds ratios (OR) and No response 2 1
95% confidence intervals (CI). Urinary 3-HPMA and Annual income a
iAs species, arsenic concentrations in dust and drinking <$52,000 4 1
water, and national percentiles for the ADI and RUCC
were compared between UCC cases and benign urologic $52,000 – 156,000 16 16
controls using Mann–Whitney tests. Urinary and >$156,000 1 6
household chemical concentrations were correlated across No response 4 2
all patients by ADI and RUCC using Spearman correlation Median years lived at 22 years 20 years
tests. current address (range) (1 – 49 years) (5 – 48 years)
Notes: Annual income in USD; *indicates statistical significance at
a
Total urinary iAs and 3-HPMA concentrations for each p=0.0013.
patient were compared to in vitro genotoxic thresholds in Abbreviation: UCC: Urothelial cell carcinoma.
primary human urothelial cells: 10 μM for iAs and 1.1 μM
for acrolein. Percentages of cases and controls reaching UCC were less likely to have completed any post-college
18
genotoxic urinary chemical concentrations were compared education compared to patients with benign urologic
using Fisher’s exact tests. disease (p=0.0013; Table 1).
3. Results 3.2. Questionnaire data
3.1. Patient demographics Patient responses to the household questionnaires are
Patients with UCC and control patients with benign listed in Table 2. There were no significant differences in the
urologic disease had comparable racial and ethnic history of industrial employment, reported drive-by traffic
backgrounds (primarily Caucasian, non-Hispanic) and near the home, use of an indoor fireplace, wood-burning
annual income levels (Table 1). However, patients with stove, or swimming pool, use of a well for drinking water,

Volume 11 Issue 3 (2025) 90 doi: 10.36922/jctr.24.00065