Fatal Arteriosclerotic Heart Disease, Water Hardness at Home, and Socioeconomic Characteristics1

Comstock, G. W. (Training Center for Public Health Research, Johns Hopkins School of Hygiene and Public Health, Box 2067, Hagerstown, Md. 21740). Fatal arteriosclerotic heart disease, water hardness at home, and socioeconomic character-istics. Amer J Epidem 94: 1–10, 1971.—Several reports have indicated an inverse correlation between the hardness of community water supplies and deaths from arteriosclerotic and degenerative heart disease. An unusual opportunity to look at this association in more detail arose in Washington County, Maryland. Drinking water sources there vary markedly in hardness, and a private census in 1963 made it possible to match cases and controls from the same defined population and to study a number of socioeconomic characteristics. During the next three years, there were 189 deaths attributed to arteriosclerotic and degenerative heart disease among white males aged 45 to 64 who could be identified in the census. For each case, 2 controls were randomly selected from the census lists and matched for race, sex and year of birth. Water samples were collected from the residences of cases and controls and examined for total hardness. No significant association of arteriosclerotic and degenerative heart disease deaths could be found with water hardness. Deaths from these causes were more common among persons of lower socioeconomic status, among cigarette smokers, and among persons who attended church infrequently. Although water hardness is not likely to be a real risk factor for cardiovascular disease, the role of trace elements in home drinking water supplies should be investigated.