(a) Bladder cancer.
| Studies | Location | Year of Publication | Sample Size | Study Design | Disinfection by-Products Measurement | Subgroups Included in the Analysis | Effect Size and CI |
|---|---|---|---|---|---|---|---|
| Wilkins and Comstock [51] | Maryland, USA | 1981 | 81 cases and 30,699 controls | Cohort | Exposure to chlorinated drinking water | Sex | All: RR = 2.2 (0.71–9.39); Men: RR = 1.80 (0.80–4.75); Women: RR = 1.60 (0.54–6.32) |
| Zierler et al. [55] | Massachusetts, USA | 1988 | 614 cases and 1074 controls | Case-control | Duration of exposure to chlorinated drinking water | n.d. | All: OR = 2.7 (1.7–4.3) |
| McGeehin et al. [53] | Colorado, USA | 1993 | 327 bladder cancer and 261 other-cancer controls | Case-control | Questionnaire & data for TTHM from site visit of water utilities | Smoking Status | Non–Smokers: OR = 2.9 (1.2–7.4); Smokers: OR = 2.1 (1.1–3.8) |
| King and Marrett [67] | Ontario, Canada | 1996 | 696 cases and 1545 controls | Case-control | Questionnaire about source of water. Water source and chlorination status were provided directly by treatment plant surveys. TTHMs modelling | n.d. | All: OR = 1.66 (1.11–2.51) |
| Freedman et al. [54] | Maryland, USA | 1997 | 294 cases and 2326 controls | Case-control | Exposure to chlorinated drinking water | Sex, smoking habits | All: OR = 1.4 (0.7–2.9); Men: OR = 2.2 (0.8–5.1); Women: OR = 0.6 (0.2–2.2) |
| Koivusalo et al. [52] | Finland | 1997 | 621 431 | Cohort | Questionnaires. Information on water-pipe connections, past drinking water quality, and treatment practices by waterworks was obtained from administrative registers and municipal waterworks. The level of mutagenicity was estimated by modelling | Sex | All: RR = 1.12 (0.93–1.36); Men: RR = 1.03 (0.82–1.28); Women: RR = 1.48 (1.01–2.18) |
| Cantor et al. [64] | Iowa, USA | 1998 | 1123 cases and 1983 controls | Case-control | TTHMs in tap water (measures + estimations) | Sex, smoking habits | All: OR = 1.3 (0.9–2.0); Men: OR = 1.8 (1.2–2.7); Women: OR = 0.6 (0.3–1.4) |
| Koivusalo et al. [56] | Finland | 1998 | 732 cases and 914 controls | Case-control | Questionnaires. Information on water-pipe connections, past drinking water quality, and treatment practices by waterworks was obtained from administrative registers and municipal waterworks. The level of mutagenicity was estimated by modelling | Sex | Men: OR = 1.17 (0.87–1.57); Women: OR = 1.14 (0.71–1.82) |
| Chevrier et al. [58] | France | 2004 | 281 cases and 272 controls | Case-control | TTHMs modelling | Sex | All: OR = 2.99 (1.1–8.5); Men: OR = 3.73 (1.2–11); Women: OR = 1.55 (0.1–32) |
| Bove et al. [59] | New York, USA | 2007 | 182 cases and 385 controls | Case-control | TTHMs in tap water + water consumption | n.d. | THM: OR = 2.34 (1.01–3.66); CLF: OR = 2.55 (1.25–4.66); BRF: OR = 3.05 (1.51–5.69); BDCM: OR = 2.49 (1.19–4.48) |
| Chang et al. [60] | Taiwan | 2007 | 403 cases and 403 controls | Case-control | TTHMs in tap water | n.d. | All: OR = 2.11 (1.43–3.11) |
| Michaud et al. [61] | Spain | 2007 | 397 cases and 664 controls | Case-control | Questionnaire and records searches (including THM measurements) | n.d. | All: OR = 2.06 (0.83–5.08) |
| Villanueva et al. [68] | Spain | 2007 | 1219 cases and 1271 controls | Case-control | Questionnaire and records searches (including THM measurements) | Sex | All: OR = 2.10 (1.09, 4.02); Men: OR = 2.53 (1.23, 5.20); Women: OR = 1.50 (0.26, 8.61) |
| Cantor et al. [62] | Spain | 2010 | 680 cases and 714 controls | Case-control | TTHMs in tap water | Gene polymorphism | All: OR = 1.8 (0.9–3.5) |
NB: n.d.: No data; OR: Odds Ratio; RR: Risk Ratio; CLF: Chloroform; BRF: Bromoform; BDCM: Bromodichloromethane; Q1: lowest THM concentrations quartile; Q4: highest THM concentrations quartile.