Inorganic Arsenic Exposure and Modifying Factors: A Systematic Evidence Map
Evidence maps employing systematic review screening tools havebeen used for identifying and categorizing chemical-specific litera-ture that may be potentially relevant to scientific assessment.Inorganic arsenic (iAs), naturally distributed throughout the Earth’scrust, is found in water, food, soil, and air. The epidemiologic evi-dence shows that iAs is associated with cancer and noncancerhuman health outcomes. Increased susceptibility to iAs-related dis-ease is associated both with intrinsic and extrinsic factors. Ourobjective was to explore the use and feasibility of the systematic evi-dence map (SEM) approach to provide a clearer picture of the avail-able literature on modifying factors that may alter the relationshipbetween iAs exposure and health effects. A literature search (2014–2022) was conducted using PubMed, Web of Science, and Toxnet toidentify studies with modifying factors of iAs health effects definedin populations, exposures, comparators, outcomes (PECO) criteria.Where applicable, health effects were also categorized. The literaturesearch identified 584 studies with modifying factors that met thePECO criteria. Studies on the following modifying factors were identi-fied: alcohol consumption (n ¼ 8), chemical co-exposure (n ¼ 104),genetic polymorphisms (n ¼ 172), lifestages (n ¼ 228), microbiome(n ¼ 6), nutritional deficiencies (n ¼ 150), preexisting conditions(n ¼ 9), sex (n ¼ 65), smoking (n ¼ 45), and other (e.g., arsenicmetabolism, epigenetics, UV/sun exposure, DNA damage/repair, cof-fee consumption) (n ¼ 227). The SEM method was effectively utilizedto identify studies on modifying factors for iAs.