Predicting risk and loss of disability-adjusted life years (DALY) from selected disinfection byproducts in multiple water supply sources in Saudi Arabia

Moving Beyond the Silos of Opportunistic Pathogen and Disinfection Byproduct Research to Improve Drinking Water System Management

Drinking water opportunistic pathogens (OPs) and disinfection byproducts (DBPs) both pose risks to public health, and their variable occurrence from source to tap complicates efforts to control them simultaneously. Management of OPs and DBPs is further hindered by the historical division between microbial and chemical research. This review brings together the current knowledge regarding OPs and DBPs, identifies factors that influence the occurrence of both, and highlights areas where research is needed to better understand their health risks. First, we examine the current understanding of how OPs and DBPs are jointly influenced by physicochemical parameters, source water characteristics, treatment processes including disinfection, and distribution system properties. Temperature, for example, can affect OP and DBP occurrence, where higher temperatures can promote the growth of some OPs, such as Legionella pneumophila, but temperature's effect on DBPs is species-dependent. Methods for quantifying the risks associated with OPs (quantitative microbial risk assessment) and DBPs (chemical risk assessment) are compared, finding that the numerous assumptions and data gaps associated with each method limit comparability across contaminant types. We highlight the urgent need to fill existing data gaps and develop a more unified risk framework so as to move toward holistic assessment of microbial and chemical risks. This review provides suggestions for future research, highlighting ways that researchers might utilize established practices in OP or DBP studies to further our understanding of the other. For example, analysis of source water organic matter composition, which has advanced our understanding of DBP formation, could be utilized to elucidate how source water characteristics influence OPs. This review bridges the gap between the OP and DBP disciplines, arguing that collaboration between the two is needed to address the pressing challenges facing water systems today.

Trihalomethanes in global drinking water: Distributions, risk assessments, and attributable disease burden of bladder cancer

This study aimed to assess the global spatiotemporal variations of trihalomethanes (THMs) in drinking water, evaluate their cancer and non-cancer risks, and THM-attributable bladder cancer burden. THM concentrations in drinking water around fifty years on a global scale were integrated. Health risks were assessed using Monte Carlo simulations and attributable bladder cancer burden was estimated by comparative risk assessment methodology. The results showed that global mean THM concentrations in drinking water significantly decreased from 78.37 μg/L (1973-1983) to 51.99 μg/L (1984-2004) and to 21.90 μg/L (after 2004). The lifestage-integrative cancer risk and hazard index of THMs through all exposure pathways were acceptable with the average level of 6.45 × 10-5 and 7.63 × 10-2, respectively. The global attributable disability adjusted of life years (DALYs) and the age-standardized DALYs rate (ASDR) dropped by 16% and 56% from 1990-1994 to 2015-2019, respectively. A big decline in the attributable ASDR was observed in the United Kingdom (62%) and the United States (27%), while China experienced a nearly 3-fold increase due to the expanded water supply coverage and increased life expectancy. However, China also benefited from the spread of chlorination, which helped reduce nearly 90% of unsafe-water-caused mortality from 1998 to 2018.

Investigating bromide incorporation factor (BIF) and model development for predicting THMs in drinking water using machine learning

Many disinfection byproducts (DBPs) in drinking water can pose cancer risks to humans while several DBPs including trihalomethanes are typically regulated. Although trihalomethanes are regulated, brominated fractions (bromodichloromethane, dibromochloromethane and bromoform) are more toxic to humans than the chlorinated ones (chloroform). To date, >100 models have been reported to predict DBPs. However, models to predict individual trihalomethanes are very limited, indicating the needs of such models. Various factors including natural organic matter (NOM), bromide ions (Br-), disinfectants (e.g., chlorine dose), pH, temperature and reaction time affect the formation and distribution of trihalomethanes in drinking water. In this study, NOM was fractionated into four groups based on the molecular weight (MW) cutoff values and their respective contributions to dissolved organic carbon (DOC), trihalomethanes and bromide incorporation factors (BIF) were investigated. Models were developed for predicting chloroform, bromodichloromethane, dibromochloromethane, bromoform and trihalomethanes. Three machine learning techniques: Support Vector Regressor (SVR), Random Forest Regressor (RFR) and Artificial Neural Networks (ANN) were adopted for training and testing the models. The normalized BIFs were in the ranges of 0.08-0.16 and 0.07-0.15 per mg/L of DOC for pH 6.0 and 8.5 respectively. The BIFs were higher for lower pH and MW values while increase of bromide to chlorine ratios increased BIFs. The models showed excellent predictive performances in training (R2 = 0.889-0.998) and testing (R2 = 0.870-0.988) datasets. The SVR and RFR models showed the best performances with lower RMSE and MAE in most cases. These models can be used to better control different trihalomethanes in drinking water to maintain regulatory compliance, and to minimize the risks to humans.

Bromoform exposure is associated with non-melanoma skin cancer: evidence from NHANES 2011-2020

Background

Non-melanoma skin cancer (NMSC) is a prevalent skin malignancy. It has been indicated in many studies that trihalomethanes (THMs) exposure has a strong association with tumors but has not been associated with NMSC. Our investigation aims to explore the association between THMs exposure and NMSC.

Methods

Cross-sectional data from the 2011 to 2020 National Health and Nutrition Examination Survey (NHANES) was collected. Poisson regression and subgroup analyses were performed to evaluate the association between individual THMs components and NMSC. Fitted smoothing curves and generalized additive models were also used.

Results

This study involved 5,715 individuals, 98 (1.7%) of whom self-reported NMSC. After adjusting for covariates, Poisson regression showed that higher blood TBM levels were associated with an increased likelihood of NMSC (OR = 1.03; 95% CI: 1.01-1.05, p = 0.002). However, the correlation between the blood levels of TCM, DBCM, and BDCM and the likelihood of NMSC was not statistically significant (all p > 0.05). Subgroup analysis and interaction tests showed no significant differences between blood TBM concentration and the likelihood of NMSC, indicating that age, gender, and race were significantly independent of this positive association (all p < 0.05).

Conclusions

Our results implied that among adults older than 65 years old in the U.S., elevated blood TBM concentrations were positively associated with NMSC. More prospective investigations are required to validate this relationship with the early prevention of NMSC.

Exploration of optimal disinfection model based on groundwater risk assessment in disinfection process

Under the influence of different types of disinfectants and disinfection environments, the removal level of pathogens and the formation potential of disinfection by-products (DBPs) will have a dual impact on the groundwater environment. The key points for sustainable groundwater safety management are how to balance the positive and negative relationship and formulate a scientific disinfection model in combination with risk assessment. In this study, the effects of sodium hypochlorite (NaClO) and peracetic acid (PAA) concentrations on pathogenic E. coli and DBPs were investigated using static-batch and dynamic-column experiments, as well as the optimal disinfection model for groundwater risk assessment was explored using quantitative microbial risk assessment and disability-adjusted life years (DALYs) models. Compared to static disinfection, deposition and adsorption were the dominant factors causing E. coli migration at lower NaClO levels of 0-0.25 mg/L under dynamic state, while disinfection was its migration factor at higher NaClO levels of 0.5-6.5 mg/L. In contrast, E. coli removed by PAA was the result of the combined action of deposition, adsorption, and disinfection. The disinfection effects of NaClO and PAA on E. coli differed under dynamic and static conditions. At the same NaClO level, the health risk associated with E. coli in groundwater was higher, whereas, under the same PAA conditions, the health risk was lower. Under dynamic conditions, the optimal disinfectant dosage required for NaClO and PAA to reach the same acceptable risk level was 2 and 0.85 times (irrigation) or 0.92 times (drinking) of static disinfection, respectively. The results may help prevent the misuse of disinfectants and provide theoretical support for managing twin health risks posed by pathogens and DBPs in water treatment.

Evaluation and strategy for improving the quality of desalinated water

Seawater desalination is practiced in many coastal countries, which is accepted as clean water by the general populations. The untreated seawater reported high concentrations of bromide (50,000 - 80,000 µg/L) and iodide (21 - 60 µg/L) ions, which are reduced to non-detectable levels during thermal desalination while the concentrations of bromide and iodide ions were reduced to 250-600 µg/L and < 4-16 µg/L, respectively during reverse osmosis processes. During the treatment and/or disinfection, many brominated and iodinated disinfection byproducts (Br-DBPs and I-DBPs) are formed in desalinated water, some of which are genotoxic and cytotoxic to the mammalian cells and possible/probable human carcinogens. In this paper, DBPs' formation in desalinated and blended water from source to tap, toxicity to the mammalian cells, their risks to humans and the strategies to control DBPs were investigated. The lifetime excess cancer risks from groundwater, and desalinated and blended water sourced DBPs were 4.15 × 10^-6 (4.72 × 10^-7 - 1.30 × 10^-5), 1.75 × 10^-5 (2.58 × 10^-6 - 5.25 × 10^-5) and 2.59 × 10^-5 (4.02 × 10^-6 - 8.35 × 10^-5) respectively, indicating higher risks from desalinated and blended water (2.56 and 4.51 times respectively) than groundwater systems. Few emerging DBPs in desalinated/blended water showed higher cyto- and genotoxicity in the mammalian cells. The findings were compared with safe drinking water standards and strategies to produce cleaner desalinated water were demonstrated.

Comparing risk of disinfection byproducts in drinking water under variable scenarios of seawater intrusion

The higher levels of halides in seawater increase bromide and iodide in the coastal aquifers, leading to higher concentrations of halogenated disinfection byproducts (DBPs). The populations in the coastal areas are susceptible to increased concentrations of DBPs while many DBPs are cyto- and genotoxic to mammalian cells, and are possible/probable human carcinogens. The implications of seawater intrusion on the concentrations of trihalomethanes (THMs) and haloacetic acids (HAAs), and the risks were analyzed by adding 0.0-2.0 % seawater (SW) (by volume) and chlorine to groundwater. Bromide and iodide concentrations in groundwater (0.0 %SW) were observed as 42.5 and non-detected (ND) μg/L respectively. With 2.0 %SW, these were spiked up to 1100 and 2.1 μg/L respectively. The most common THMs (THM4), iodinated THMs (I-THMs) and HAAs were 30.4, 0.13 and 27.9 μg/L for 0.0 % SW respectively. With 2.0 %SW, these values were 106.3, 1.6 and 72.9 μg/L, respectively. At 0.0 %SW, averages of chronic daily intakes (CDI) for THM4, HAAs and I-THMs were 2.61 × 10^-4, 2.26 × 10^-4 and 7.69 × 10^-7 mg/kg/day respectively, which were increased to 9.97 × 10^-4, 4.70 × 10^-4 and 9.47 × 10^-6 mg/kg/day, respectively for 2.0 %SW. For 0.0 %SW, overall cancer risks from few DBPs was 3.09 × 10^-5 (6.46 × 10^-6 - 7.23 × 10^-5) while at 1.0 % and 2.0 %SW, risks were 4.88 × 10^-5 (1.26 × 10^-5-1.08 × 10^-4) and 4.11 × 10^-5 (1.21 × 10^-5-9.28 × 10^-5) respectively. The reduction of risks for 2.0 %SW was due to the increase of bromoform (TBM), and decrease in bromodichloromethane (BDCM) and dibromochloromethane (DBCM) at 2.0 %SW. The disability-adjusted life years (DALY) loss showed an increasing trend from 0.0 %SW (DALY: 77.30) to 1.0 %SW (DALY: 122.0) while an increase to 2.0 %SW showed a decrease in DALY (DALY: 102.8). Future study on toxicity of other regulated and emerging DBPs is warranted to better predict cancer risks.

Exposure and carcinogenic risk assessment of trihalomethanes (THMs) for water supply consumers in Addis Ababa, Ethiopia

Background

Trihalomethanes (THMs), a class of DBPs (disinfection byproducts) that includes chloroform, bromodichloromethane (BDCM), chlorodibromomethane (CDBM), and bromoform. To the best of authors' knowledge, no study has addressed the relationship between the concentration of THMs and lifetime cancer risks (LCR) in drinking water supply system in Addis Ababa, Ethiopia. Therefore, this study aimed to determine the lifetime cancer risks of exposure to THMs in Addis Ababa, Ethiopia.

Method

A total of 120 duplicate water samples were collected from 21 sampling points in Addis Ababa, Ethiopia. The THMs were separated by a DB-5 capillary column and detected by an electron capture detector (ECD). Cancer and non-cancer risk assessments were performed.

Results

The average total THMs (TTHMs)concentration in Addis Ababa, Ethiopia, was 76.3 μg/L. Chloroform was the most dominant THM species identified. The total cancer risk for males was higher than that for females. The average LCR for TTHMs via ingestion in drinking water in this study was unacceptably high risk 93.4 × 10 - 2 . An average LCR through dermal routes was also of unacceptably high risk 4.3 × 10 - 2 . The LCR by chloroform contributes the highest (72%) of the total risk, followed by BDCM (14%), DBCM (10%) and bromoform (4%).

Conclusions

The cancer risk of drinking water due to THMs in Addis Ababa was higher than the level recommended by the USEPA. The total LCR from the targeted THMs was higher via the three exposure routes. Males were at higher THM cancer risk than females. The hazard index (HI) indicated that the dermal route caused higher HI values than the ingestion route. It is essential to apply alternatives to chlorine, i.e., chlorine dioxide (ClO₂), ozone and ultraviolet radiation, in Addis Ababa, Ethiopia. The monitoring and regulation of the THMs is required on a regular basis to analyse the trends and guide the water treatment and distribution system.

Availability of data and materials

The datasets generated for this analysis are available from the corresponding author upon reasonable request.

Health impacts of air pollution in Chinese coal-based clean energy industry: LCA-based and WTP-oriented modeling

The evolution of energy system occupies an important position in economic development and quality of life. Influenced by the energy endowment in China, developing the coal-based clean energy industry has been regarded as a guaranteed path to realizing the clean and efficient use of coal resources. However, an evaluation paradigm that could systematically assess the health impacts of airborne pollution in this industry is still lacking, which is our concern. Combining with life cycle analysis, probabilistic risk models, and health impact models, this study proposes a series of models which are consistent enough to unite pollutant concentration, health risk, and health impact, and equip assessment results with more intuitive significance of life and economic loss. Further, case studies for three typical clean coal technologies, namely, coal mining, coal-fired power generation, and coal liquefaction, are presented to verify the reliability of these models. Results show that the most severe health impact occurred at the worksite of driving face, the substage of coal combustion, and coal mining and processing, respectively, for the three technologies. Further, coal dust brought about the greatest pollution to coal mining and coal liquefaction, and for coal-fired power generation, SO₂, NO₂, and PM₁₀ were the commonest and toughest pollutants. In conclusion, the proposed evaluation paradigm can help to find out the worksite, substage, and airborne pollutant with the most severe impact and is more intuitive to provide references for minimizing or eliminating environmental pollution. Additionally, three aspects of implications are confirmed in this study, namely, social mobilization promoting, government policy making, and environmental pollution prejudging.

Removal of halides from drinking water: technological achievements in the past ten years and research needs

Disinfection is an essential process for drinking water supplies resulting in the formation of unintended disinfection by-products (DBPs), many of which are potentially toxic and are known as the possible or probable human carcinogens. As of now, 100⁺ DBPs were characterized while about 600⁺ others can be formed in the supply water. To protect the human health, many regulatory agencies have set the guideline values for several DBPs. Removal of halide ions and natural organic matter prior to disinfection is an important step to reduce DBPs, and the associated exposure and risks. To date, many publications have reported various methods for halide removal from drinking water. The most review about halide removal technologies, associated challenges, and future research needs was published in 2012. Since then, a number of studies have been published on different methods of halide removal techniques. This paper aims to review the state of research on halide removal techniques focusing on the development during the past 10 years (2012-2021). The techniques were clustered into six major groups: adsorption, ion exchange, coagulation, advanced oxidation, membrane separation, and combined techniques. The progress on these groups of technologies, their advantages, and limitations were examined, and the future research directions to produce the safe drinking water were identified.

Prevalence and Trends of Drinking Water Disinfection Byproducts-Related Cancers in Addis Ababa, Ethiopia

BACKGROUND

Disinfection byproducts (DBPs) from chlorinated drinking water have been linked to an increased risk of cancer in the bladder, stomach, colon, and rectum. No studies showed the independent trends and prevalence of these cancers in Ethiopia. Therefore, this study aimed to determine the prevalence and trends of disinfection byproducts-related cancers in Addis Ababa, Ethiopia.

METHODS

Data were collected from the Addis Ababa Cancer Registry. Spatial data sets were produced and classified into households receiving chlorinated surface water and less chlorinated groundwater. The Cochran-Armitage trend test was used to evaluate whether there was a disinfection byproducts-related cancers (DBRCs) trend among communities receiving chlorinated water. Negative binomial regression was used to analyze the incidence rate.

RESULTS

A total of 11, 438 cancer cases were registered between 2012 and 2016, and DBRCs accounted for approximately 17%. The majority of the total cancer cases were female; 7,706 (67%). The prevalence of DBRCs was found to be higher in communities supplied with chlorinated water. From 2012 to 2016, the trend of colon cancer increased (β = 10.3, P value = .034); however, esophageal cancer decreased (β = -6.5, P value = .018). Approximately 56% of colorectal cancer patients and 53% of stomach cancer patients are known to be using chlorinated surface water for drinking regularly. In addition, approximately 57.1% and 54% of kidney and bladder cancer patients, respectively, used chlorinated surface water.

CONCLUSION

The prevalence of DBRCs in this study was found to be high. The colon cancer trend increased substantially from 2012 to 2016. The prevalence of DBRCs was higher in communities supplied with chlorinated surface water. Similarly, the prevalence of DBRCs was higher among males than females. Further study is required to validate the association between DBRCs and water chlorination.

Effects of seawater intrusion on the formation of disinfection byproducts in drinking water

Seawater contains high levels of halides, which can increase the concentrations of bromide and iodide ions in coastal groundwater and surface water sources. Intrusion of seawater alters the chemistry of fresh water leading to the formation of additional brominated and iodinated disinfection byproducts (DBPs), many of which are cyto- and genotoxic to the mammalian cells, and have cancer risks to humans. In this study, effects of seawater intrusion on the formation of trihalomethanes (THMs), and haloacetic acids (HAAs) were investigated by spiking groundwater using 0.0-2.0% seawater (by volume) and liquid chlorine as disinfectant. The concentrations of bromide and iodide ions in groundwater (0.0% seawater) were 42.5 and non-detected (ND) μg/L respectively, which were increased up to 1100 and 2.1 μg/L respectively, following mixing with 2.0% seawater. The regulated THMs (THM4) were increased from 30.4 to 106.3 μg/L while iodinated THMs (I-THMs) were increased from 0.13 to 1.6 μg/L respectively due possibly to molecular substitution and additional pathways of THMs formation. Bromoform was increased from 0.5 to 94.3 μg/L while iodoform was increased from ND to 1.02 μg/L. HAAs were increased from 27.9 to 72.9 μg/L where tribromoacetic acid was increased from 2.0 to 43.7 μg/L. In 0.0% seawater, bromine incorporation factor (BIF) for THM4 and HAAs were 0.077 and 0.050 respectively, which were increased to 0.942 and 0.38 at 2% seawater respectively. For dihalogenated HAAs (X2AA) and trihalogenated HAAs (X3AA), BIF in 0.0% seawater were 0.098 and 0.14 respectively, which were increased to 0.863 and 0.924 for 2.0% seawater respectively. Mixing of 2.0 seawater increased the toxicity of THM4, HAAs and I-THMs by 4.2, 5.9 and 201.8 folds, respectively indicating the importance of reducing seawater intrusion into the freshwater sources. Further, alteration of water sources and/or adaptation of advanced treatment can assist in lowering the risks.

Drinking Water Source, Chlorinated Water, and Colorectal Cancer: A Matched Case-Control Study in Ethiopia

BACKGROUND

There is no study conducted on the association between disinfection byproducts (DBPs) in chlorinated drinking water and colorectal cancer (CRC) in Ethiopia. Therefore, this study aimed to determine the relation between chlorine based DBPs in drinking water and CRC in Addis Ababa, Ethiopia.

METHODS

A facility based matched case control study was conducted involving 224 cases and 448 population controls from June 2020 to May 2021. Cases were defined as histologically confirmed CRC cases. Cases were matched with controls by residence, age, and sex using frequency and individual matching. Geocoding of cases, health facility, and georeferencing of controls were carried out. Data was collected using a pretested structured questionnaire. Pearson Chi square and Fisher's exact tests were employed to assess associations. Stratified analysis was used to detect confounding factors and effect modification. A multivariable conditional logistic regression was used to identify risk factors of CRC.

RESULTS

Of 214 CRC cases, 148 (69.2%) used chlorinated water whereas out of 428 controls 161 (37.6%) used chlorinated water. In the final regression model, drinking chlorinated surface water (adjusted matched odds ratio [adjusted mOR] = 2.6; 95% CI 1.7-4.0), history of swimming (adjusted mOR = 2.4; 95% CI 1.4-4.1), years at the place of current residence (adjusted mOR = 1.5; 95% CI 1.1-2.2), hot tap water use for showering (adjusted mOR; 3.8 = 95% CI 2.5-5.9) were significantly associated with CRC. The stratified analysis confirmed that smoking and meat ingestion were not effect modifiers and confounders.

CONCLUSION

Drinking chlorinated water for extended years is a significant risk factor for CRC in Addis Ababa, Ethiopia. In addition, hot tap water use for showering, and swimming history are risk factors for CRC. This information is essential to design integrated interventions that consider chlorination by-products and exposure routes toward the prevention and control of CRC in Ethiopia. Initiating alternative methods to chlorine disinfection of drinking water is also essential.