LIFE Project Number LIFE 17 ENV/SK/000036 Acronym: LIFE – WATER and HEALTH SHORT REPORT Characteristics of health status in municipalities with different types of water hardness. (Summary. The full text of the report is in attachment) (Activity B.1: Risk Analysis) 05/11/2019 Anna Letkovičová, Stanislav Rapant, Viktor Kosmovský, Veronika Cvečková, Juraj Macek Abstract The report appreciates the health status and demographic trend of two groups of municipalities supplied with drinking water of different hardness compared to the entire population of the Slovak Republic (SR). The aim was to determine if there are differences in health status depending on the different hardness of drinking water. The health status of 1994 - 2008 (15 years) was evaluated. The data originate from the registers of the Statistical Office of the Slovak Republic and are therefore guaranteed by the state. The first group of municipalities that is supplied with "soft" drinking water (Ca - 20.7 mg l-1, Mg - 6.05 mg l-1, (Ca Mg) - 0.77 mmol l-1) consisted of 34 municipalities and 52,676 inhabitants in total. The second group of municipalities that is supplied with "hard" drinking water (Ca-70.1 mg l-1, Mg-26.4 mg l-1, (Ca Mg) - 2.88 mmol l-1) consisted of 21 municipalities and 53,118 inhabitants lived there. As reference group, 2,762 municipalities of the SR (99.87% of the population) were used. Municipalities under 100 inhabitants that give unreliable results in health indicators were excluded from all municipalities of the Slovak Republic. The selected municipalities in both groups were similar in number and each group represented approximately 1% of the Slovak population. The health status of the population in both groups was monitored with using 96 health indicators (HI) divided by age 1 and sex. We present the results of the 13 most important health indicators including life expectancy, crude mortality, premature death rate, years of life lost and relative and indirectly standardized mortality for four main causes of death in Slovakia; namely cardiovascular system, malignant tumors, digestive and respiratory systems. All examined and evaluated health indicators exhibited statistically significantly better values in the group of municipalities with “hard” water. No single health indicator was found that would be better in a group of municipalities with “soft” water. In comparison with the whole territory of the Slovak Republic is the result the same. The group of municipalities with “hard” water exhibits all health indicators better than the average of the Slovak Republic and the group of municipalities with “soft” water has all health indicators worse comparing the average of the Slovak Republic. The group of municipalities with “soft” drinking water has absolute deaths as well as species-specific and relativized deaths more than 50% higher (i.e. worse) than the group of municipalities with “hard” drinking water. Contrary, the life expectancy is better in the group of municipalities with “hard” water in all age categories. People live statistically demonstrably longer. When averaging all used health indicators are the health indicators in the group of municipalities with “soft” water 62% higher, consequently worse than in a group of municipalities with "hard" water. Neither of indicators is lower (i.e. better). Besides the life expectancy that is 4.5 years higher in the group of municipalities with “hard” water. INTRODUCTION The aim of this activity was to confirm the current knowledge that the health status of people supplied with drinking water with higher hardness (for simplification in the following we use the term "hard" water) is better than the health status of people who are supplied with drinking water of lower hardness (soft” water). E.g. in Yang et al. (1998), Catling et al. (2005), Runenowitz-Lundin a Hiscok (2005), Selinus et al. (2005), Rosborg I. ed. (2015), Rapant et al. (2017), Koppová et al. (2017). According to the project, two groups of municipalities were random selected, which are supplied with drinking water of different hardness, namely those with more than 50,000 inhabitants in each group of municipalities, as established in the project. A total of 96 health indicators were compiled for both groups of municipalities, divided according to the age and sex. For comparison we used the whole population of the Slovak Republic from which municipalities under 100 inhabitants were excluded. The final assessment of the health status of both groups of municipalities included 13 most important HIs including expected life expectancy, crude mortality, percentage of premature deaths, years of life lost and relative indirect-age standardized mortality for the four main causes of death in Slovakia – cardiovascular system, malignant tumors, digestive and respiratory systems. All results in the health status differences of the two population groups were subjected to statistical analysis – T-test, ANOVA and Kolmogorov-Smirnov test by Statgraphic system. 2 SELECTION OF MUNICIPALITIES As mentioned in terms of the project we have selected two groups of municipalities. Each group includes at least 50,000 inhabitants. We chose them based on the chemical composition of the water. The first group of municipalities, (in following referred as 'soft' water), consisted of municipalities supplied with drinking water with a low Ca content of approximately 30 mg l-1 and less, Mg approximately 10 mg l-1and below and a low total water hardness of about 1 mmol l-1 and less. The second group of municipalities (referred as “hard” water) consisted of municipalities with a higher to high Ca content of approximately 50 mg l-1and more, Mg approximately 25 mg l-1 and more and the total water hardness value is about 2.5 mmol l-1and more. We have selected municipalities with at least 500 inhabitants. The only exception was the village Devičie with 302 inhabitants. This municipality was included in the group of “soft” water because of the fact that there will be drinking water recarbonized. The population numbers were selected not random. From previous work (e.g. Rapant et al, 2010; Fajčíková et al., 2016) it is obvious that small municipalities under 500 inhabitants often show unbalanced health indicators due to a small number of inhabitants (small number error). On the other hand, large municipalities (towns) with more than 10,000 inhabitants are often supplied with various drinking water from several sources. We also want to avoid the fact that if we selected 4 - 5 municipalities with 10,000 inhabitants and more, we would not be able to obtain the necessary variability of health indicators. Inhabitants of municipalities ranging from 500 to 5,000 of inhabitants show the most balanced indicators in health indicators and are most closely related to the environment (Rapant et al., 2010; Fajčíková et al., 2016). Therefore we have chosen the municipalities as described. In the case of a group of municipalities of “soft” water due to the fact that these (drinking) groundwater originate from a low water-saturated silicate geological basement with low water yield, we had to select more municipalities into this group. Municipalities with several thousand inhabitants supplied with soft drinking water occur in Slovakia only in a very limited number. Overview of the basic chemical parameters of water for the group of municipalities “soft“ water is shown in Tab. 1 and for the group of municipalities 'hard' water in Tab. 2. In Fig. 1 is presented the HI distribution of individual municipalities. 3 Table 1 Basic chemical parameters for municipalities group „soft“ water. Number of the Conductivity Ca Mg (Ca + Mg) Municipality District Geology pH population [µS cm-1] [mg l-1] [mg l-1] [mmol l-1] Hiadeľ Banská Bystrica 3 515 7.60 315.00 33.00 15.70 1.47 Šumiac 2 1,334 7.74 86.00 11.00 2.50 0.38 Braväcovo 2 703 6.52 116.00 11.40 2.90 0.40 Bacúch 2 995 7.14 50.00 7.60 2.00 0.27 Pohorelá Brezno 2 2,332 7.96 62.00 8.10 2.30 0.30 Jasenie 2 1,188 7.74 186.00 30.20 5.90 1.00 Hronec 2 1,192 7.83 338.00 40.00 16.80 1.69 Čierny Balog 2 5,214 7.11 97.00 11.00 2.30 0.37 Látky 2 578 6.80 190.30 8.90 2.20 0.31 Detvianska Huta 2 708 6.11 53.80 5.40 3.00 0.26 Podkriváň Detva 2 599 8.34 170.00 21.60 4.40 0.72 Stožok 6 952 7.36 150.00 13.00 4.10 0.49 Vígľaš 6 1,697 8.19 167.00 24.70 3.00 0.74 Litava 6 767 7.31 230.00 21.50 7.40 0.84 Krupina 6 8,007 7.20 185.00 21.60 7.70 0.86 Litava Krupina 6 767 7.31 250.00 21.50 7.40 0.84 Cerovo 6 603 7.37 185.00 26.40 11.60 1.14 Devičie 6 302 7.01 280.00 30.00 10.2 1.15 Pukanec Levice 6 1,984 7.59 380.00 48.90 9.24 1.60 Prochot Žiar n/Hronom 6 595 7.30 150.00 12.40 6.90 0.59 Dobroč 2 643 8.31 154.00 30.30 4.00 0.92 Divín Lučenec 2 2,061 8.36 150.00 19.50 6.20 0.74 Rapovce 8 978 8.85 117.00 18.20 5.40 0.68 Kokava nad 2 3,000 8.00 140.00 19.10 3.50 0.62 Rimavicou Kalinovo Poltár 8 2,229 8.60 126.00 17.60 2.00 0.52 Poltár 8 5,754 8.76 165.00 29.10 2.00 0.81 Utekáč 2 1,027 7.10 112.00 15.90 2.02 0.70 Rudník Košice – okolie 1 631 7.16 186.00 17.80 7.70 0.76 Rakovec nad 6 1,085 7.52 189.00 37.00 2.90 1.04 Ondavou Michalovce Poruba pod 6 627 7.28 178.00 24.80 4.50 0.80 Vihorlatom Čierna Lehota Rožňava 2 617 6.50 113.00 19.70 3.90 0.65 Kluknava 1 1,623 8.03 220.00 20.60 7.20 0.81 Kojšov 1 741 7.40 215.00 20.80 8.10 0.85 Mníšek nad Hnilcom Gelnica 1 1,717 7.20 198.00 21.20 6.50 0.80 Žakarovce 1 724 7.72 205.00 25.80 5.20 0.86 Smolník 1 1,183 7.60 100.00 14.20 3.50 0.50 arithmetic average 7.55 172.48 21.20 5.66 0.77 SLOVAC REPUBLIC 7.33 93.56 28.29 3.50 Note 1 – Paleozoic, metasediments, metavolcanites; 2 – Crystalline, granitoids and crystalline schists; 3 – Mesozoic carbonates and basal Paleogene sediments, limestones, dolomites, conglomerates; 6 – neovolcanites, andesites, basalts and pyroclastics; 8 – Qauternery, gravels, sands, loams, rock clasts; Number of the population for “soft” water 52,676 (31.