Health effects of arsenic exposure in Latin America: An overview of the past eight years of research

Advanced application of nano-technological and biological processes as well as mitigation options for arsenic removal

Arsenic (As) removal is a huge challenge, since several million people are potentially exposed (>10 μg/L World Health Organization guideline limit) through As contaminated drinking water worldwide. Review attempts to address the present situation of As removal, considering key topics on nano-technological and biological process and current progress and future perspectives of possible mitigation options have been evaluated. Different physical, chemical and biological methods are available to remove As from contaminated water/soil/wastes, where removal efficiency mainly depends on absorbent type, initial adsorbate concentration, speciation and interfering species. Oxidation is an important pretreatment step in As removal, which is generally achieved by several media such as O₂/O₃, HClO, KMnO₄ and H₂O₂. The Fe-based-nanomaterials (α/β/γ-FeOOH, Fe₂O₃/Fe₃O₄-γ-Fe₂O₃), Fe-based-composite-compounds, activated-Al₂O₃, HFO, Fe-Al₂O₃, Fe₂O₃-impregnated-graphene-aerogel, iron-doped-TiO₂, aerogel-based- CeTiO₂, and iron-oxide-coated-manganese are effective to remove As from contaminated water. Biological processes (phytoremediation/microbiological) are effective and ecofriendly for As removal from water and/or soil environment. Microorganisms remove As from water, sediments and soil by metabolism, detoxification, oxidation-reduction, bio-adsorption, bio-precipitation, and volatilization processes. Ecofriendly As mitigation options can be achieved by utilizing an alternative As-safe-aquifer, surface-water or rainwater-harvesting. Application of hybrid (biological with chemical and physical process) and Best-Available-Technologies (BAT) can be the most effective As removal strategy to remediate As contaminated environments.

Distribution of Groundwater Arsenic in Uruguay Using Hybrid Machine Learning and Expert System Approaches

Groundwater arsenic in Uruguay is an important environmental hazard, hence, predicting its distribution is important to inform stakeholders. Furthermore, occurrences in Uruguay are known to variably show dependence on depth and geology, arguably reflecting different processes controlling groundwater arsenic concentrations. Here, we present the distribution of groundwater arsenic in Uruguay modelled by a variety of machine learning, basic expert systems, and hybrid approaches. A pure random forest approach, using 26 potential predictor variables, gave rise to a groundwater arsenic distribution model with a very high degree of accuracy (AUC = 0.92), which is consistent with known high groundwater arsenic hazard areas. These areas are mainly in southwest Uruguay, including the Paysandú, Río Negro, Soriano, Colonia, Flores, San José, Florida, Montevideo, and Canelones departments, where the Mercedes, Cuaternario Oeste, Raigón, and Cretácico main aquifers occur. A hybrid approach separating the country into sedimentary and crystalline aquifer domains resulted in slight material improvement in a high arsenic hazard distribution. However, a further hybrid approach separately modelling shallow (<50 m) and deep aquifers (>50 m) resulted in the identification of more high hazard areas in Flores, Durazno, and the northwest corner of Florida departments in shallow aquifers than the pure model. Both hybrid models considering depth (AUC = 0.95) and geology (AUC = 0.97) produced improved accuracy. Hybrid machine learning models with expert selection of important environmental parameters may sometimes be a better choice than pure machine learning models, particularly where there are incomplete datasets, but perhaps, counterintuitively, this is not always the case.

Meet-in-metabolite analysis: A novel strategy to identify connections between arsenic exposure and male infertility

BACKGROUND

Despite a trend in the use of systems epidemiology to fill the knowledge gap between risk-factor exposure and adverse outcomes in the OMICS data, such as the metabolome, seriously hindrances need to be overcome for identifying molecular connections.

OBJECTIVES

Using male infertility phenotypes and arsenic exposure, we aimed to identify intermediate biomarkers that reflect both arsenic exposure and male infertility with a meet-in-metabolite analysis (MIMA).

METHODS

Urinary arsenic levels and metabolome were measured by using inductively coupled plasma-mass spectrometry (ICP-MS) and HPLC-quadrupole time-of-flight mass spectrometry (HPLC-QTOF-MS), respectively. To identify arsenic-related metabolic markers (A-MIMA), the intermediate markers were profiled by orthogonal projections to latent structures (OPLS-DA). To detect infertility-related metabolic markers (I-MIMA), the intermediate markers were investigated by weighted gene co-expression network analysis. The key node markers, related to both A-MIMA and I-MIMA, were determined by O2PLS and defined as MIMA markers. Finally, network analysis was used to construct the MIMA-related metabolic network.

RESULTS

Twelve markers each were defined through the significant associations with arsenic exposure (A-MIMA) and/or infertility (I-MIMA), respectively. Seven of them, including acetyl-N-formyl-5-methoxykynurenamine, carnitine, estrone, 2-oxo-4-methylthiobutanoic acid, malonic acid, valine, and LysoPC (10:0), were defined through the associations with both arsenic exposure and male infertility (MIMA markers). These intermediate markers were involved majorly in oxidative stress, one-carbon metabolism, steroid hormone homeostasis, and lipid metabolism pathways. The core correlation network analysis further highlighted that testosterone is a vital link between the effect of arsenic and male infertility.

CONCLUSIONS

From arsenic exposure to male infertility, the arsenic methylation that coupled one-carbon metabolism disruption with oxidation stress may have extended its effect to fatty acid oxidation and steroidogenesis dysfunction. Testosterone is at the hub between arsenic exposure and male infertility modules and, along with the related metabolic pathways, may service as a potential surrogate marker in risk assessment for male dysfunction due to arsenic exposure.

Arsenic exposure in Indo Gangetic plains of Bihar causing increased cancer risk

Reportedly, 300 million people worldwide are affected by the consumption of arsenic contaminated groundwater. India prominently figures amongst them and the state of Bihar has shown an upsurge in cases affected by arsenic poisoning. Escalated arsenic content in blood, leaves 1 in every 100 human being highly vulnerable to being affected by the disease. Uncontrolled intake may lead to skin, kidney, liver, bladder, or lung related cancer but even indirect forms of cancer are showing up on a regular basis with abnormal arsenic levels as the probable cause. But despite the apparent relation, the etiology has not been understood clearly. Blood samples of 2000 confirmed cancer patients were collected from pathology department of our institute. For cross-sectional design, 200 blood samples of subjects free from cancer from arsenic free pockets of Patna urban agglomeration, were collected. Blood arsenic levels in carcinoma patients as compared to sarcomas, lymphomas and leukemia were found to be higher. The geospatial map correlates the blood arsenic with cancer types and the demographic area of Gangetic plains. Most of the cancer patients with high blood arsenic concentration were from the districts near the river Ganges. The raised blood arsenic concentration in the 2000 cancer patients strongly correlates the relationship of arsenic with cancer especially the carcinoma type which is more vulnerable. The average arsenic concentration in blood of the cancer patients in the Gangetic plains denotes the significant role of arsenic which is present in endemic proportions. Thus, the study significantly correlates and advocates a strong relation of the deleterious element with the disease. It also underlines the need to address the problem by deciphering the root cause of the elevated cancer incidences in the Gangetic basin of Bihar and its association with arsenic poisoning.

Phytoextraction of arsenic using a weed plant Calotropis procera from contaminated water and soil: growth and biochemical response

Developing effective and environment-friendly alternatives to remove arsenic (As) from soil and water systems is of great importance and phytoremediation may be a promising alternative in this direction. Weeds have wide geographical distribution, not a part of food chain, well adapted to adverse conditions and reported to grow at various heavy metal contaminated sites. The present work delineates potential of a weed plant Calotropis procera L. for the remediation and translocation of As from water and soil and this plant has been found efficient in remediating significant quantities of As after 15 and 30 d when exposed to a range of concentrations. Moreover, As accumulation was found more in shoots than the roots when exposed to higher As levels for 30d having translocation factor >1 and make this plant suitable for phytoextraction of As. Effect of As on plant growth, photosynthetic pigments and lipid peroxidation in response to As is also presented here. The activities of antioxidant enzymes, superoxide dismutase, ascorbate peroxidase, guaiacol peroxidase and catalase were found to increase in response to As stress. High As accumulation and tolerance potential of C. procera from artificially As contaminated water and soil coupled with good growth and its phytoextraction ability suggests the feasibility of this plant for the phytoremediation of As from contaminated water and soils.

Maternal and childhood exposure to inorganic arsenic and airway allergy - A 15-Year birth cohort follow-up study

BACKGROUND

The prevalence of allergic diseases in children has increased globally. Early-life exposure to inorganic arsenic has been found to be associated with impaired immune function and decreased lung function in children; however, the results are inconsistent. We aimed to evaluate the effect of prenatal and childhood exposure to inorganic arsenic on allergic diseases in children, through a 15-year follow-up birth cohort study, conducted in central Taiwan.

METHODS

Children born to women enrolled in the Taiwan Maternal and Infant Cohort Study (TMICS-pilot) from December 2000 to November 2001 were recruited and followed every 2-3 years until the age of 14 years. Urinary specimens were collected in the pregnant women during the 3rd trimester and the followed children. Diagnoses of allergic diseases were based on physician diagnoses using the International Study of Asthma and Allergies in Childhood questionnaire. Urinary arsenic speciation was performed using high-performance liquid chromatography and inductively coupled plasma dynamic reaction cell mass spectrophotometry.

RESULTS

Of the 261 children from 358 mother-infant pairs for this study, those with asthma and allergic rhinitis reported a higher prevalence of maternal allergy (49.47%) than did non-allergic children (29.81%). In the fully adjusted model, levels of maternal urine (iAs + MMA + DMA) greater than the median were found to be significantly associated with an increased risk of asthma (OR = 4.28; 95% CI 1.32, 13.85). Levels of urinary (iAs + MMA + DMA) in children higher than the median were associated with an increased risk of allergic rhinitis (OR = 2.26; 95% CI 1.20, 4.26).

CONCLUSION

Prenatal and childhood exposure to inorganic arsenic were found to be significantly associated with the occurrence of asthma and allergic rhinitis in children, respectively. Further large cohort follow-up studies are important to validate the association between inorganic arsenic exposure and allergic diseases in children.

FRA1 is essential for the maintenance of the oncogenic phenotype induced by in vitro long-term arsenic exposure

Arsenic induces oncogenic effects activating stress-related signalling pathways. This can result in the over-activation of the AP-1 protein, specifically its FRA1 component. FRA1 is a transcription factor frequently overexpressed in epithelial tumors, where it can regulate the expression of different target genes. Accordingly, FRA1 could play an essential role in the in vitro cell transformation induced by arsenic. FRA1 levels were monitored in MEF cells throughout their transformation stages during 40 weeks of long-term 2 μM arsenic exposure. Interestingly, the results show a progressive FRA1 overexpression with time (60-fold and 11-fold for mRNA and pFRA/non-pFRA1, respectively, at week 40), which may be responsible for the observed altered expression in the FRA1 downstream target genes Pten, Pdcd4, Tpm1, Tgfb1, Tgfb2, Zeb1, Zeb2, and Twist. The levels of MAPKs (ERK, p38, and JNK) and other known players upstream from FRA1 were assessed at equivalent time-points, and ERK, p38 and RAS were pinpointed as potential candidates involved in arsenic-induced FRA1 activation. Furthermore, FRA1 stable knockdown under chronic arsenic exposure settings elicits a remarkable impact on the features relative to the cells' oncogenic phenotype. Notably, FRA1 knockdown cells present a 30% diminished proliferation rate, a 50% lowered migration and invasion potential, a 50% reduction in senescence, and a 30-60% reduced tumorsphere-forming ability. This work is the first to demonstrate the important role of FRA1 in the development and aggressiveness of the in vitro transformed phenotype induced by long-term arsenic exposure.

Arsenic Exposure and Cancer-Related Proteins in Urine of Indigenous Bolivian Women

Indigenous people living in the Bolivian Andes are exposed through their drinking water to inorganic arsenic, a potent carcinogen. However, the health consequences of arsenic exposure in this region are unknown. The aim of this study was to evaluate associations between arsenic exposure and changes in cancer-related proteins in indigenous women (n = 176) from communities around the Andean Lake Poopó, Bolivia. Arsenic exposure was assessed in whole blood (B-As) and urine (as the sum of arsenic metabolites, U-As) by inductively coupled plasma-mass spectrometry (ICP-MS). Cancer-related proteins (N = 92) were measured in urine using the proximity extension assay. The median B-As concentration was 2.1 (range 0.60-9.1) ng/g, and U-As concentration was 67 (12-399) μg/L. Using linear regression models adjusted for age, urinary osmolality, and urinary leukocytes, we identified associations between B-As and four putative cancer-related proteins: FASLG, SEZ6L, LYPD3, and TFPI2. Increasing B-As concentrations were associated with lower protein expression of SEZ6L, LYPD3, and TFPI2, and with higher expression of FASLG in urine (no association was statistically significant after correcting for multiple comparisons). The associations were similar across groups with different arsenic metabolism efficiency, a susceptibility factor for arsenic toxicity. In conclusion, arsenic exposure in this region was associated with changes in the expression of some cancer-related proteins in urine. Future research is warranted to understand if these proteins could serve as valid biomarkers for arsenic-related toxicity.

Assessing arsenic in human toenail clippings using portable X-ray fluorescence

Arsenic is a toxic metalloid which has been associated with a wide range of health effects in humans including skin abnormalities and an elevated risk of skin, bladder, kidney, and lung cancer, diabetes, and cardiovascular disease. The measurement of arsenic concentration in nail clippings is often used in population studies as an indicator of arsenic exposure. Portable X-ray fluorescence (XRF) is an emerging technique for measuring arsenic in nail clippings. In the current study, single toenail clippings from 60 Atlantic Canadian participants were assessed for arsenic using a new portable XRF approach. A mono-energetic portable XRF system using doubly curved crystal optics was used to measure each clipping for a total of 900 s. Energy spectra from each clipping were analyzed for arsenic characteristic X-rays to provide a normalized arsenic signal. The same clippings were then analyzed for arsenic concentration using a "gold standard" method of inductively coupled plasma mass spectrometry (ICP-MS). Nail clipping arsenic concentrations measured by ICP-MS ranged from 0.030 μg/g to 2.57 μg/g, with a median result of 0.14 μg/g. Portable XRF results for arsenic were compared against ICP-MS arsenic concentrations, with a linear equation of best fit determined between the two variables. A correlation coefficient of r = 0.77 was found from the 59 nail clippings returning an ICP-MS arsenic concentration above the limit of quantitation. When the comparison was limited to the 20 clippings having an XRF normalized signal at least twice as large as the associated uncertainty of measurement, the correlation coefficient was r = 0.89. With the selection of an arsenic concentration of 0.1 μg/g as a cut-off value between "exposed" and "non-exposed" individuals, the XRF method provided a test sensitivity of 76% and a specificity of 81%. The corresponding positive predictive value was 88% and the negative predictive value was 65%. The portable XRF technique used in this study shows promise as a means of assessing arsenic concentration in toenail clippings.

Arsenic, cadmium, mercury, and lead levels in hair and urine in first-year RUDN University students of different geographic origins

The objective of the present study was to assess the markers of arsenic, cadmium, mercury, and lead exposure in first-year RUDN University students of different geographic origins. A total of 274 first-year students of the RUDN University originating from Russia (n = 65), Asia (n = 57), Middle East (n = 84), Africa (n = 40), and Latin America (n = 28) were enrolled in the present study. Evaluation of As, Cd, Hg, and Pb levels in urine and hair was performed using inductively coupled plasma-mass spectrometry. The obtained data demonstrate that hair As levels in foreign students exceed that in Russian examinees. The highest Cd and Pb levels were detected in subjects from Africa and Latin America, whereas hair Hg content was significantly higher in Latin America students. Urinary Cd levels in foreign students exceeded those in Russian counterparts. In turn, the highest Hg concentration in urine was revealed in students originating from Middle East and especially Latin America. Urinary Pb levels were found to be the highest in students from Africa. Multiple regression analysis demonstrated that Asian, African, and Latin American origins were considered as a significant predictor of hair Hg content. Higher urinary Hg levels were associated with Asia, Middle East, and Latin American origins. Prior habitation in Africa and Asia was considered as predictor of higher hair Pb and urinary Cd levels. The observed difference may be indicative of geographic difference in toxic metal exposure patterns.

Iron-based subsurface arsenic removal (SAR): Results of a long-term pilot-scale test in Vietnam

The principle of subsurface arsenic removal (SAR) from groundwater is based on oxidation and adsorption reactions by infiltrating oxygen into the anoxic aquifer and the immobilization of arsenic (As) onto freshly formed iron (Fe)-(hydr)oxides. In this study, a pilot-scale plant for SAR has been subject to long term testing in the Mekong Delta, Vietnam. Initial concentrations of Fe (8.4 ± 1.3 mg L^-1) and As (81 ± 8 μg L^-1) in the exploited groundwater were successfully lowered to below the WHO guideline value limits for drinking water of 0.3 mg L^-1 and 10 μg L^-1, respectively. Adsorption and co-precipitation of As with Fe-(hydr)oxides could be identified as the principal mechanism responsible for the As removal from groundwater, demonstrating the feasibility of SAR as a low-cost and zero-waste solution over a period of two years. However, naturally occurring geochemical reducing conditions and high ammonium levels in the groundwater delayed the removal of manganese (Mn). An additional post-treatment filtration for Mn-removal was temporarily used to comply with the Vietnamese drinking water standard until a Mn-mitigation was achieved by the SAR process. In contrast to most As-remediation technologies, SAR appears to be a long-term, sustainable treatment option with the salient advantage of negligible production of toxic waste, which with ex-situ processes require additionally management costs.

The dynamic effects of different inorganic arsenic species in crucian carp (Carassius auratus) liver during chronic dietborne exposure: Bioaccumulation, biotransformation and oxidative stress

Inorganic arsenic (iAs) is highly toxic to aquatic species, but the chronic effect of iAs on fish following dietborne exposure is still unclear. In this study, freshwater fish crucian carp (Carassius auratus) was exposed to iAs [arsenite (AsIII) and arsenate (AsV)] for 40 days through dietary exposure. The bioaccumulation and biotransformation of arsenic in the main metabolic organ, liver, were measured. The oxidative stress responses to iAs exposure in liver were analyzed to be linked to arsenic biotransformation, especially methylation. In both AsIII and AsV groups, the total As contents gradually increased during the exposure and then fleetly decreased at the end of exposure (40 d). Arsenobetaine was found to be the predominated As species (34-66%) and the fraction remained on an increasing trend, while the inorganic As percentages decreased 84-91% during the 40-day exposure, suggesting that the capability of As biotransformation increased to acclimate iAs during chronic dietborne exposure. Both the activities of the enzymatic antioxidants (superoxide dismutase and catalase) and the level of the nonenzymatic antioxidant (glutathione) increased initially and then decreased, thus lowering the malondialdehyde levels and displaying a typical antioxidant defense mechanism. The opposite correlations were observed between arsenic secondary methylation index and the malondialdehyde level in different iAs treatment. This indicated that the As dimethylation played an significant role toward oxidative damage; the toxic action of As dimethylation was dependent upon the parent iAs species at the initial stage of exposure. Therefore, the effectiveness of the detoxification relied on both the biomethylation rate of As and the anti-oxidation ability based on nonenzymatic antioxidant and enzymatic antioxidant.

As3MT and GST Polymorphisms Influencing Arsenic Metabolism in Human Exposure to Drinking Groundwater

The urinary arsenic metabolites may vary among individuals and the genetic factors have been reported to explain part of the variation. We assessed the influence of polymorphic variants of Arsenic-3-methyl-transferase and Glutathione-S-transferase on urinary arsenic metabolites. Twenty-two groundwater wells for human consumption from municipalities of Colombia were analyzed for assessed the exposure by lifetime average daily dose (LADD) (µg/kg bw/day). Surveys on 151 participants aged between 18 and 81 years old were applied to collect demographic information and other factors. In addition, genetic polymorphisms (GSTO2-rs156697, GSTP1-rs1695, As3MT-rs3740400, GSTT1 and GSTM1) were evaluated by real time and/or conventional PCR. Arsenic metabolites: As^III, As^V, monomethylarsonic acid (MMA), and dimethylarsinic acid (DMA) were measured using HPLC-HG-AFS. The influence of polymorphic variants, LADD and other factors were tested using multivariate analyses. The median of total arsenic concentration in groundwater was of 33.3 μg/L and the median of LADD for the high exposure dose was 0.33 µg/kg bw/day. Univariate analyses among arsenic metabolites and genetic polymorphisms showed MMA concentrations higher in heterozygous and/or homozygous genotypes of As3MT compared to the wild-type genotype. Besides, DMA concentrations were lower in heterozygous and/or homozygous genotypes of GSTP1 compared to the wild-type genotype. Both DMA and MMA concentrations were higher in GSTM1-null genotypes compared to the active genotype. Multivariate analyses showed statistically significant association among interactions gene-gene and gene-covariates to modify the MMA and DMA excretion. Interactions between polymorphic variants As3MT*GSTM1 and GSTO2*GSTP1 could be potential modifiers of urinary excretion of arsenic and covariates as age, LADD, and alcohol consumption contribute to largely vary the arsenic individual metabolic capacity in exposed people.

Arsenic in geoenvironments of Nicaragua: Exposure, health effects, mitigation and future needs

In contrast to other Latin American countries, where the presence of arsenic (As) in drinking water sources and related adverse human health impacts are well-known, little is internationally known from Nicaragua. However, the As problem is of high relevance as numerous assessments by national research, governmental and non-governmental institutions have proven. To assess for the first time and globally disseminate this predominantly nationally originated information is the aim of this review. In Nicaragua, >1000 water samples have been analyzed for total As from 1991 to 2017. By today, 144 communities distributed within 12 departments and one autonomous region (RACCS) are impacted with As. At least 55,700 people are exposed to drinking water with As (n = 173; range: 10-1320 μg/L, mean: 48.30 μg/L; 21.95%). Arsenic in surface water ranged from 0.99 to 2650 μg/L (n = 124, mean: 65.62 μg/L, 62.9% < 10 μg/L); and in groundwater from 0.10 to 1320 μg/L [n = 624, mean: 20.86 μg/L (70.7% < 10 μg/L)]. The highest As concentration was recorded from a well of the El Zapote community in 1996 (1320 μg/L), alerting national authorities and academic's to research As in water sources and health risks. Since then, 10 μg As/L has been the national regulatory limit for drinking water supplies. Occurrence of high As levels is linked to three geoenvironments: (i) Paleocene-Mesozoic metamorphic rocks (Northern Highlands) where As is present in epithermal veins, (ii) Tertiary volcanic rocks (Central Plateau) where As is related to fossil hydrothermal/volcanic systems, (iii) Quaternary rocks (Nicaragua Depression) where As is caused by active geothermal/volcanic activities. No mitigation measures have been implemented. Incipient water treatment efforts (Kanchan filters activated carbon) have failed because they were not socially accepted. More integrated, cross-sectorial research on genesis, health impacts and problem mitigation is needed. Provision of water treatment units for As removal on a single-household and community scale is needed, calling for the cooperation of national entities with communities in problem detection and solving.

Use of low-enthalpy and waste geothermal energy sources to solve arsenic problems in freshwater production in selected regions of Latin America using a process membrane distillation - Research into model solutions

The challenge for many communities in Latin America is to find adequate solutions which are feasible given the local economic and technical conditions and which enable them to source water with arsenic concentrations below the WHO guideline value for drinking water (<10 μg/L) of arsenic (As) pollution, suitable for human consumption and the irrigation of crops. Three regions where geothermal fields are present were selected for study out of the several hundred locations in Latin America where the water environment is contaminated with As and where there is a critical water shortage problem. These are Cerro Prieto in Mexico, Momotombo in Nicaragua and Lake Poopó in Bolivia. The paper presents the results of research on the use of low-enthalpy geothermal energy sources and waste heat from geothermal power plants in membrane distillation (MD) processes, which is the only heat-powered membrane technology, in order to obtain potable water and/or water for crop irrigation. It was concluded that MD could be considered as a solution for obtaining water of good quality with a high retention of toxic solutes such as As as well as other different species found in groundwater. In addition, it is not only geothermal energy, but also the geothermal water itself that can be considered as a source of freshwater produced through the MD process, a process which is most suitable to be used in areas where cheap sources of heat are available.

Ethnicity and survival in bladder cancer: a population-based study based on the SEER database

Background

Bladder cancer is the most common cancer in the urinary system and the fourth most common cancer in males. This study aimed to examine differences in the survival of bladder cancer patients of different ethnicities.

Method

We used the SEER database to obtain data pertaining to bladder cancer patients from 2010 to 2015. Univariate and multivariate Cox proportional hazards regression analyses were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between ethnicity and death. Kaplan–Meier survival and nomogram analyses were used to compare survival differences among patients with different ethnicities.

Results

Among 101,364 bladder cancer patients, 90,910 were white, 5893 were black, 337 were American Indian/Alaska Native (AIAN), and 4224 were Asian or Pacific Islander (API). Our multivariate analysis identified differences between different ethnicities. Compared to the API group, the AIAN (HR = 1.31, 95% CI = 1.09–1.57, P < 0.001), black (HR = 1.56, 95% CI = 1.46–1.67, P < 0.001), and white (HR = 1.18, 95% CI = 1.12–1.25, P < 0.001) groups showed lower survival probabilities. Based on data from all Kaplan–Meier survival curves, there was no significant difference in survival between the black and AIAN groups, but the survival of these two races was worse than that of the white and API groups. We also used a nomogram to estimate patient survival and validated its predictive value.

Conclusion

Our results suggest that ethnic differences exist in patients with bladder cancer, that the survival of black and AIAN bladder cancer patients is worse than that of other ethnicities and that the survival of API patients is the best. The significant prognostic factors of overall survival, which include age, sex, ethnicity, summary stage, American Joint Committee on Cancer stage, surgery type, and histologic type, should be applied to bladder cancer patient prognostication.