WATER HARDNESS AND CARDIOVASCULAR MORTALITY
WATER HARDNESS AND CARDIOVASCULAR MORTALITY
复制标题
水硬度和心血管死亡率
DOI：
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发表时间：
1978
影响因子：
5.2
通讯作者：
H. Johansen
中科院分区：
文献类型：
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作者：
L. Neri;H. Johansen
自从 1957 年小林指出日本河流水酸度的地理分布与当时日本主要死亡原因之一中风的分布之间存在相似之处以来，世界各地越来越多的研究人员试图阐明和确认饮用水质量与死亡率（特别是心血管疾病死亡率）之间的地理关系。目前该领域的大量文献已受到多项综合性研究的影响。与这些研究的地理多样性一样引人注目的是，大胆的研究人员所青睐的假设也多种多样，既涉及他们所归因的水传播因素的好坏影响，也涉及疾病或引起的病理过程的性质。最近，我们对过去 15 年中对文献做出贡献的人们缺乏任何新的共识表示遗憾，而且大多数研究未能提供能够区分需要考虑的 64 种主要解释假设类别中的任何一种的证据。小林没有提到中风以外的任何类别，但从施罗德开始的生态研究通常尝试将几种特定原因的死亡率作为因变量。因此，尽管大多数研究人员继续提到居住在软水地区的危险，就好像它与心血管疾病特别相关一样，但由于承认支气管炎效应 lo 以及英格兰、威尔士 11、l2 和可能的加拿大 13 也存在婴儿死亡率效应的建议，对这一观点的支持逐渐减弱，尽管美国没有。 14 股票 l5 表明，无论是什么环境或遗传因素导致了英国心血管疾病的区域死亡率模式，似乎对中枢神经系统先天性畸形的发生率也有显着影响，并且在较小程度上这也适用于肾炎和胃癌。在美国，Sauer 16 发现硬度与恶性肿瘤的负相关性与心血管死亡的负相关性一样强，加拿大的统计数据 17 显示，软水地区超过一半的超额死亡率被证明是非心血管死亡原因。由于水因素真正影响的不确定性，一些研究人员区分心血管死亡率的各个组成部分，希望找出更具体的关联。例如，
Ever since Kobayashi,' in 1957, noted a parallel between the geographic distribution of the acidity of water in Japanese rivers and the distribution of what was then one of the major causes of mortality in Japan, apoplexy, an increasing number of investigators all over the world have attempted to elucidate and confirm a geographic relationship between quality of drinking water and mortality, particularly from cardiovascular causes. The now voluminous literature in this field has been subject to several comprehensive As remarkable as the geographic diversity of these studies is the great diversity of the hypotheses that have been favored by daerent investigators, both as regards the identity of the water-borne factor to which they impute a good or bad influence, and as regards the nature of the disease or pathologic process induced. Re~ently,~ we expressed regret at the lack of any emerging consensus among those who have contributed to the literature over the last 15 years, and at the failure of most studies to yield evidence capable of discriminating among any of 64 major classes of explanatory hypotheses that need to be considered. Kobayashi did not refer to any category other than apoplexy, but ecological studies, from Schroeder on, have usually tried several cause-specific death rates as dependent variables. Thus, even though most investigators continue to refer to the hazard of residing in soft-water areas as if it related specifically to cardiovascular disease, support for this view has been progressively weakened by the admission of a bronchitis effect lo and by the suggestion that there is also an infant mortality effect in England, Wales 11, l2 and possibly Canada,13 though not in the United States.14 Stocks l5 showed that whatever may be the environmental or genetic factor responsible for regional mortality patterns of cardiovascular disease in the United Kingdom, it would appear to have a pronounced effect also on the incidence of congenital malformation of the central nervous system, and to a lesser extent this would apply to nephritis and carcinoma of the stomach. In the United States, Sauer l6 found as strong a negative correlation of hardness with malignant neoplasm as with cardiovascular deaths, Canadian statistics l7 show that more than half the excess mortality in soft-water areas is certified to noncardiovascular causes of death. Uncertainty as to the real effect of the water factor has lead some investigators to discriminate between various components of cardiovascular mortality in the hope of identifying a more specific association. For example,