Ferrandiz, JuanAbellan, Juan JGomez-Rubio, VirgilioLopez-Quilez, AntonioSanmartin, PilarAbellan, CarlosMartinez-Beneito, Miguel AMelchor, InmaculadaVanaclocha, HermelindaZurriaga, OscarBallester, FerranGil, Jose MPerez-Hoyos, SantiagoOcana, Ricardo2015-08-062015-08-062004-04-15Ferrandiz J, Abellan JJ, Gomez-Rubio V, Lopez-Quilez A, Sanmartin P, Abellan C, et al. Spatial analysis of the relationship between mortality from cardiovascular and cerebrovascular disease and drinking water hardness Environ Health Perspect. 2004; 112(9): 1037-440091-6765http://hdl.handle.net/10668/1954Journal Article; Research Support, Non-U.S. Gov't; Reproduced with permission from Environmental Health Perspectives.Previously published scientific papers have reported a negative correlation between drinking water hardness and cardiovascular mortality. Some ecologic and case-control studies suggest the protective effect of calcium and magnesium concentration in drinking water. In this article we present an analysis of this protective relationship in 538 municipalities of Comunidad Valenciana (Spain) from 1991-1998. We used the Spanish version of the Rapid Inquiry Facility (RIF) developed under the European Environment and Health Information System (EUROHEIS) research project. The strategy of analysis used in our study conforms to the exploratory nature of the RIF that is used as a tool to obtain quick and flexible insight into epidemiologic surveillance problems. This article describes the use of the RIF to explore possible associations between disease indicators and environmental factors. We used exposure analysis to assess the effect of both protective factors--calcium and magnesium--on mortality from cerebrovascular (ICD-9 430-438) and ischemic heart (ICD-9 410-414) diseases. This study provides statistical evidence of the relationship between mortality from cardiovascular diseases and hardness of drinking water. This relationship is stronger in cerebrovascular disease than in ischemic heart disease, is more pronounced for women than for men, and is more apparent with magnesium than with calcium concentration levels. Nevertheless, the protective nature of these two factors is not clearly established. Our results suggest the possibility of protectiveness but cannot be claimed as conclusive. The weak effects of these covariates make it difficult to separate them from the influence of socioeconomic and environmental factors. We have also performed disease mapping of standardized mortality ratios to detect clusters of municipalities with high risk. Further standardization by levels of calcium and magnesium in drinking water shows changes in the maps when we remove the effect of these covariates.enAdultoAncianoCalcioEnfermedades CardiovascularesTrastornos CerebrovascularesNiñoPreescolarAnálisis por ConglomeradosExposición a Riesgos AmbientalesEstudios EpidemiológicosSistemas de Información GeográficaHumanosLactanteMagnesioMasculinoMediana EdadValores de ReferenciaMedición de RiesgoAguaAbastecimiento de aguaMedical Subject Headings::Named Groups::Persons::Age Groups::AdultMedical Subject Headings::Named Groups::Persons::Age Groups::Adult::AgedMedical Subject Headings::Chemicals and Drugs::Inorganic Chemicals::Metals::Metals, Alkaline Earth::CalciumMedical Subject Headings::Diseases::Cardiovascular DiseasesMedical Subject Headings::Diseases::Nervous System Diseases::Central Nervous System Diseases::Brain Diseases::Cerebrovascular DisordersMedical Subject Headings::Named Groups::Persons::Age Groups::ChildMedical Subject Headings::Named Groups::Persons::Age Groups::Child::Child, PreschoolMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Statistics as Topic::Cluster AnalysisMedical Subject Headings::Health Care::Environment and Public Health::Public Health::Environmental Pollution::Environmental ExposureMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic StudiesMedical Subject Headings::Check Tags::FemaleMedical Subject Headings::Information Science::Information Science::Information Storage and Retrieval::Databases as Topic::Databases, Factual::Geographic Information SystemsMedical Subject Headings::Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::HumansMedical Subject Headings::Named Groups::Persons::Age Groups::InfantMedical Subject Headings::Named Groups::Persons::Age Groups::Infant::Infant, NewbornMedical Subject Headings::Chemicals and Drugs::Inorganic Chemicals::Metals::Metals, Light::MagnesiumMedical Subject Headings::Check Tags::MaleMedical Subject Headings::Named Groups::Persons::Age Groups::Adult::Middle AgedMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Weights and Measures::Reference ValuesMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Statistics as Topic::Probability::Risk::Risk AssessmentMedical Subject Headings::Chemicals and Drugs::Inorganic Chemicals::Hydroxides::WaterMedical Subject Headings::Health Care::Environment and Public Health::Public Health::Sanitation::Sanitary Engineering::Water Supplyresearch article15198925open access1552-9924PMC1247198