Disinfection by-products (DBPs), including trihalomethanes (THMs) and haloacetic acids (HAAs), have attracted attention due to their carcinogenic properties, leading to varying conclusions. This meta-analysis aimed to evaluate the dose-response relationship and the dose-dependent effect of DBPs on cancer risk. We performed a selective search in PubMed, Web of Science, and Embase databases for articles published up to September 15th, 2023. Our meta-analysis eventually included 25 articles, encompassing 8 cohort studies with 6038,525 participants and 10,668 cases, and 17 case-control studies with 10,847 cases and 20,702 controls. We observed a positive correlation between increased cancer risk and higher concentrations of total trihalomethanes (TTHM) in water, longer exposure durations, and higher cumulative TTHM intake. These associations showed a linear trend, with relative risks (RRs) and 95 % confidence intervals (CIs) being 1.02 (1.01-1.03), 1.04 (1.02-1.06), and 1.02 (1.00-1.03), respectively. Gender-specific analyses revealed slightly U-shaped relationships in both males and females, with males exhibiting higher risks. The threshold dose for TTHM in relation to cancer risk was determined to be 55 µg/L for females and 40 µg/L for males. A linear association was also identified between bladder cancer risk and TTHM exposure, with an RR and 95 % CI of 1.08 (1.05-1.11). Positive linear associations were observed between cancer risk and exposure to chloroform, bromodichloromethane (BDCM), and HAA5, with RRs and 95 % CIs of 1.02 (1.01-1.03), 1.33 (1.18-1.50), and 1.07 (1.03-1.12), respectively. Positive dose-dependent effects were noted for brominated THMs above 35 µg/L and chloroform above 75 µg/L. While heterogeneity was observed in the studies for quantitative synthesis, no publication bias was detected. Exposure to TTHM, chloroform, BDCM, or HAA5 may contribute to carcinogenesis, and the risk of cancer appears to be dose-dependent on DBP exposure levels. A cumulative effect is suggested by the positive correlation between TTHM exposure and cancer risk. Bladder cancer and endocrine-related cancers show dose-dependent and positive associations with TTHM exposure. Males may be more susceptible to TTHM compared to females.

Disinfection is an effective process to inactivate pathogens in drinking water treatment. However, disinfection byproducts (DBPs) will inevitably form and may cause severe health concerns. Previous research has mainly focused on DBPs formation during the disinfection in water treatment plants. But few studies paid attention to the formation and transformation of DBPs in the water distribution system (WDS). The complex environment in WDS will affect the reaction between residual chlorine and organic matter to form new DBPs. This paper provides an overall review of DBPs formation and transformation in the WDS. Firstly, the occurrence of DBPs in the WDS around the world was cataloged. Secondly, the primary factors affecting the formation of DBPs in WDS have also been summarized, including secondary chlorination, pipe materials, biofilm, deposits and coexisting anions. Secondary chlorination and biofilm increased the concentration of regular DBPs (e.g., trihalomethanes (THMs) and haloacetic acids (HAAs)) in the WDS, while Br- and I- increased the formation of brominated DBPs (Br-DBPs) and iodinated DBPs (I-DBPs), respectively. The mechanism of DBPs formation and transformation in the WDS was systematically described. Aromatic DBPs could be directly or indirectly converted to aliphatic DBPs, including ring opening, side chain breaking, chlorination, etc. Finally, the toxicity of drinking water in the WDS caused by DBPs transformation was examined. This review is conducive to improving the knowledge gap about DBPs formation and transformation in WDS to better solve water supply security problems in the future.

Safe drinking water is a fundamental human right, yet more than 785 million people do not have access to it. The burden of water management disproportionately falls on women and young girls, and they suffer the health, psychosocial, political, educational, and economic effects. While water conditions and disease outcomes have been widely studied, few studies have summarized the research on drinking water and implications for gender equity and empowerment (GEE).
A systematic review of primary literature published between 1980 and 2019 was conducted on drinking water exposures and management and the implications for GEE. Ten databases were utilized (EMBASE, PubMed, Web of Science, Cochrane, ProQuest, Campbell, the British Library for Development Studies, SSRN, 3ie International Initiative for Impact Evaluation, and clinicaltrials.gov). Drinking water studies with an all-female cohort or disaggregated findings according to gender were included.
A total of 1280 studies were included. GEE outcomes were summarized in five areas: health, psychosocial stress, political power and decision-making, social-educational conditions, and economic and time-use conditions. Water quality exposures and implications for women\'s health dominated the literature reviewed. Women experienced higher rates of bladder cancer when exposed to arsenic, trihalomethanes, and chlorine in drinking water and higher rates of breast cancer due to arsenic, trichloroethylene, and disinfection byproducts in drinking water, compared to men. Women that were exposed to arsenic experienced higher incidence rates of anemia and adverse pregnancy outcomes compared to those that were not exposed. Water-related skin diseases were associated with increased levels of psychosocial stress and social ostracization among women. Women had fewer decision-making responsibilities, economic independence, and employment opportunities around water compared to men.
This systematic review confirms the interconnected nature of gender and WaSH outcomes. With growing attention directed towards gender equity and empowerment within WaSH, this analysis provides key insights to inform future research and policy.

Water contamination through anthropogenic and industrial activities has led to the emergence and necessity of disinfection methods. Chlorine and bromine gases, often used to disinfect water, resulted in the by-product formation by reacting with organic matter. The Disinfectant by-products (DBP) led to the formation of Trihaloaceticacid (TAA), Trihalomethane (THM), and other minor components. The release of chemicals has also led to the outbreak of diseases like infertility, asthma, stillbirth, and types of cancer. There are new approaches that are found to be useful to compensate for the generation of toxic by-products and involve membrane technologies, namely reverse osmosis, ultrafiltration, and nanofiltration. This review mainly focuses on the toxicology effects of DBPs and various approaches to mitigate the same. The health hazards caused by different DBPs and the various treatment techniques available for the removal are discussed. In addition, a critical comparison of the different removal techniques was discussed.

The study aimed to examine the associations between the level of trihalomethanes and its metabolites in pregnancy and the risks of adverse birth outcomes. We searched the databases of the China National Knowledge Infrastructure, WanFang, Vip, PubMed, and Elsevier Science Direct from database establishment to July 14, 2021 and performed a systematic review and meta-analysis of observational studies reporting associations between trihalomethanes level and abnormally low birth weight and preterm birth. The pooled odds ratio (OR), pooled risk ratio, and pooled risk difference with their 95% confidence interval (CI) were calculated for risk estimates. A total of 24 studies involving 1,118,037 pregnant women were finally enrolled in the present systematic review and meta-analysis. Our research found that abnormally low birth weight was associated with higher levels of total trihalomethanes (OR = 2.45, 95% CI: 1.28, 4.68; P = 0.007). Unexpectedly, the meta-analysis indicated that higher total trihalomethanes level was associated with lower odds of preterm birth (OR = 0.90, 95% CI: 0.81, 0.99; P = 0.03). Our findings indicate that trihalomethanes exposure might be a risk factor for abnormally low birth weight and that it would be prudent to minimize exposure to trihalomethanes during pregnancy because of the risk of abnormally low birth weight. Given some limitations of the systematic review and meta-analysis, our results should be interpreted with caution.

The unintended formation of disinfection by-products (DBPs) has received considerable attention as it may pose risks to human health. Coagulation is the most common process for removing particulates as well as dissolved organic matter (DOM) (i.e., DBP precursors) during drinking water and wastewater treatments. With the improvement of water quality standards and the increased fluctuation in source water quality, conventional coagulation becomes challenging. Thus, significant efforts have been made to enhance coagulation to promote the removal of DOM in source water and mitigate the formation of DBPs in drinking water. This review provides a brief summary of the properties of DBP precursors and summarizes the effectiveness of enhanced coagulation involving three types of coagulants (metal-based coagulants, organic polymers, and organic-inorganic hybrid coagulants) in controlling the formation of DBPs during chlor(am)ination disinfection. Metal-based coagulants can achieve a reduction in DBP formation potential of approximately 20%-60% in natural water under enhanced coagulation conditions. Both the organic polymers (used as coagulant aids) and novel hybrid coagulants increase the removal of DOM and exhibit high potential for mitigating DBP formation. In addition, integrated treatments combining coagulation with other treatment processes (e.g., oxidation, membrane filtration, ion exchange, and adsorption) to enhance DBP precursor removal are evaluated in terms of performance, mechanisms, and features. Advanced treatments, such as membrane filtration and activated carbon adsorption, are effective coagulation-assisted processes, and can further control chlorinated DBPs; however, the elevated formation of bromate or highly brominated DBPs is of particular concern.

Disinfection is considered as a vital step to ensure the supply of clean and safe drinking water. Various approaches are adopted for this purpose; however, chlorination is highly preferred all over the world. This method is opted owing to its several advantages. However, it leads to the formation of certain by-products. These chlorination disinfection by-products (DBPs) are genotoxic, carcinogenic and mutagenic. Still chlorination is being practiced worldwide. Present review gives insights into the occurrence, toxicity and factors affecting the formation of regulated (THMs, HAAs) and emerging DBPs (N-DBPs, HKs, HAs and aromatic DBPs) found in drinking water. Furthermore, remediation techniques used to control DBPs have also been summarized here. Key findings are: (i) concentration of regulated DBPs surpassed the permissible limit in most of the regions, (ii) high chlorine dose, high NOM, more reaction time (up to 3 h) and high temperature (up to 30 °C) enhance the formation of THMs and HAAs, (iii) high pH favors the formation of THMs while low pH is suitable of the formation of HAAs, (iv) high NOM, low temperature, low chlorine dose and moderate pH favors the formation of unstable DBPs (N-DBPs, HKs and HAs), (v) DBPs are toxic not only for humans but for aquatic fauna as well, (vi) membrane technologies, enhanced coagulation and AOPs remove NOM, (vii) adsorption, air stripping and other physical and chemical methods are post-formation approaches (viii) step-wise chlorination is assumed to be an efficient method to reduce DBPs formation without any treatment. Toxicity data revealed that N-DBPs are found to be more toxic than C-DBPs and aromatic DBPs than aliphatic DBPs. In majority of the studies, merely THMs and HAAs have been studied and USEPA has regulated just these two groups. Future studies should focus on emerging DBPs and provide information regarding their regulation.

With the development of analytical technology, more emerging disinfection by-products (DBPs) have been identified and detected. Among them, aromatic DBPs, especially heterocyclic DBPs, possess relatively high toxicity compared with regulated DBPs, which has been proved by bioassays. Thus, the occurrence of aromatic DBPs is of great concern. This article provides a comprehensive review and summary of the characteristics, occurrence, transformation pathways and control of aromatic DBPs. Aromatic DBPs are frequently detected in drinking water, wastewater and swimming pool water, among which swimming pool water illustrates highest concentration. Considering the relatively high concentration and toxicity, halophenylacetonitriles (HPANs) and halonitrophenols (HNPs) are more likely to be toxicity driver among frequently detected phenyl DBPs. Aromatic DBPs can be viewed as important intermediate products of dissolved organic matter (DOM) during chlor(am)ination. High molecular weight DOM could convert to aromatic DBPs via direct or indirect pathways, and they can further decompose into regulated aliphatic DBPs such as trihalomethanes (THMs) and haloacetic acids (HAAs) by ring opening and side chain cleavage. Even though no single DBPs control strategy is efficient to all aromatic DBPs, the decrease of overall toxicity may be achieved by several methods including absorption, solar radiation and boiling. By systematically considering aromatic DBPs and aliphatic DBPs, a better trade-off can be made to reduce health risk induced by DBPs.

Water disinfection, primarily by chlorination, is one of the greatest achievements of public health. However, more than half a century after its introduction, studies in the 1970s reported that (a) chlorine interacted with organic matter in the water to form disinfection by-products (DBPs); (b) two DBPs, chloroform and bromoform, both trihalomethanes (THMs), were rodent carcinogens; (c) three brominated THMs were mutagenic; in six studies chlorinated drinking waters in the United States and Canada were mutagenic; and (d) in one epidemiological study there was an association between bladder cancer mortality and THM exposure. This led the U.S. Environmental Protection Agency to issue its first DBP regulation in 1979. Forty years later, >600 DBPs have been characterized, 20/22 have been shown to be rodent carcinogens, >100 have been shown to be genotoxic, and 1000s of water samples have been found to be mutagenic. Data support a hypothesis that long-term dermal/inhalation exposure to certain levels of the three brominated THMs, as well as oral exposure to the haloacetic acids, combined with a specific genotype may increase the risk for bladder cancer for a small but significant population group. Improved water-treatment methods and stricter regulations have likely reduced such risks over the years, and further reductions in potential risk are anticipated with the application of advanced water-treatment methods and wider application of drinking water regulations. This 40-year research effort is a remarkable example of sustained cooperation between academic and government scientists, along with public/private water companies, to find answers to a pressing public health question.

We examined trends in incidence of bladder cancer in 8 countries in the 45+ years since trihalomethanes (THMs) were detected in chlorinated drinking water. Total trihalomethanes (TTHMs) are the principal regulated disinfection by-products (DBPs) along with halogenated acetic acids (HAAs). Numerous epidemiological studies have examined exposure to TTHMs and associations with bladder cancer. Concentrations of TTHM have declined in most of the 8 countries that were studied as has smoking prevalence. Incidences of bladder cancer have usually stayed relatively flat, especially for females, with some variations. Since THMs are not carcinogens in whole animal tests, they may not be appropriate surrogates for studying potential cancer risks in drinking water. Etiology of bladder cancer is complex; incidence correlates with age. Previously identified risk factors include smoking, type 2 diabetes, sex, ethnicity, arsenic, aromatic amines, and occupations. As a predominant risk factor, smoking trends may dominate incidence rates, but additional time might be required to determine whether a DBP risk exists due to long latency periods. Causal drinking water-related bladder cancer risks remain questionable and likely small compared to other factors, although surrogate-based DBP management is an appropriate strategy for maintaining drinking water quality as long as it does not compromise microbial disinfection.