Background: Arsenic exposure can cause adverse health effects. The effects of long-term low-to-moderate exposure and methylations remain unclear. Objective: This study aims to examine the association between low-to-moderate arsenic exposure and urothelial tract cancers while considering the effects of methylation capacity. Methods: In this study, 5,811 participants were recruited from an arseniasis area in Taiwan for inorganic arsenic metabolite analysis. This follow-up study was conducted between August 1995 and December 2017. We identified 85 urothelial tract cancers in these participants, including 49 bladder and 36 upper urothelial tract cancer cases. A Cox proportional hazards model was employed. Results: The analyses revealed a significant association between concentrations of inorganic arsenic in water > 100 ug/L and bladder cancer occurrence, with a hazard ratio (HR) of 4.88 (95% CI 1.35–17.61). A monotonic trend was observed between concentrations of inorganic arsenic in water (from 0 to > 100 ug/L) and the incidence of urothelial tract cancer, including bladder cancer (p < 0.05) and upper urothelial tract cancers (p < 0.05). Participants with a lower primary methylation index or higher secondary methylation index had a prominent effect. Conclusions: Rigorous regulations and active interventions should be considered for populations with susceptible characteristics.

Original languageEnglish
Pages (from-to)807-815
Number of pages9
JournalJournal of Epidemiology and Global Health
Issue number4
Publication statusPublished - Dec 2023


  • Bladder cancer
  • Dose–response relationship
  • Long latency arsenic exposure
  • Methylation capacity
  • Upper urothelial tract cancers

ASJC Scopus subject areas

  • Epidemiology


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