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Health and economic impact of nitrate pollution in drinking water: a Wisconsin case study

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Nitrate contamination of drinking water, common in agricultural areas, increases the risk of certain cancers and impacts fetal development during pregnancy. Building on previously published methodology, this study evaluates nitrate-attributable disease cases and adverse birth outcomes as well as their economic costs for Wisconsin, USA. Nitrate is the most common contaminant in groundwater in Wisconsin. Two-thirds of the state’s residents use groundwater as the primary source of drinking water. Here, we analyze nitrate exposure from drinking water in Wisconsin based on nitrate test results for community water systems for the period of 2010–2017 and a novel methodology for estimating nitrate exposure for the 28% of state’s residents who use private wells. We estimate that annually, 111–298 combined cases of colorectal, ovarian, thyroid, bladder, and kidney cancer in Wisconsin may be due to nitrate contamination of drinking water. Each year, up to 137–149 cases of very low birth weight, 72–79 cases of very preterm birth, and two cases of neural tube defects could be due to nitrate exposure from drinking water. The direct medical cost estimates for all nitrate-attributable adverse health outcomes range between $23 and $80 million annually. Simulating targeted reductions in the counties with the highest current drinking water nitrate concentrations resulted in similar reductions in adverse health outcomes as statewide reduction efforts, up to nitrate reductions of 20%. Time trend analysis suggests that groundwater nitrate concentrations are overall increasing. Thus, nitrate contamination of water supplies in Wisconsin is a public health problem that needs to be addressed.

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Data availability

This study used publicly accessible datasets from the state of the Wisconsin Department of Natural Resources and Department of Agriculture, Trade and Consumer Protection as described in the text. All data and analyses are available from the corresponding author upon request.


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The authors gratefully acknowledge Henry Anderson, Mark Borchardt, and Scott Laeser for their helpful feedback on earlier versions on this manuscript. We also thank the Wisconsin Department of Natural Resources and Department of Agricultural Trade and Consumer Protection staff for assistance in obtaining water quality data and information about public water systems. We thank the Brico, Brookby, and McKnight foundations for their support of Clean Wisconsin’s water program work.

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This research was supported by grants from the Brico, Brookby, and McKnight foundations (USA) for authors from the Clean Wisconsin (P.D.M., T.B., and A.J.) and grants from Park Foundation (USA) for authors from the Environmental Working Group (S.E. and O.V.N.).

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Conceptualization, P.D.M.; methodology, P.D.M., S.E., and O.V.N.; analysis, P.D.M, T.B., A.J., and S.E.; data curation P.D.M.; writing—original draft preparation, P.D.M.; writing—review and editing, P.D.M., S.E., and O.N.

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Correspondence to Paul D. Mathewson.

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Supplemental Figure 1

Wisconsin land cover from the WiscLand 2.0 dataset, overlaid with the Wisconsin Department of Natural Resources’ Management Regions. (Made in ESRI ArcMap 10.5) (PNG 5585 kb)

High resolution image (TIF 3642 kb)

Supplemental Figure S2a

Example plots of nitrate concentrations over time for transient noncommunity wells. Fig. S2a is an example of a source well that may have had a nitrate treatment process installed but not listed in the database, as suggested by the rapid decline in nitrate concentration to very low levels. However, the majority of source wells with a significant declining trend are more similar to Fig. S2b, which shows a gradual decline, suggesting a real decline in the groundwater. (Made in R Studio) (PNG 23 kb)

High resolution image (TIFF 29 kb)

Supplemental Figure S2b

(PNG 27 kb)

High resolution image (TIFF 31 kb)


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Mathewson, P.D., Evans, S., Byrnes, T. et al. Health and economic impact of nitrate pollution in drinking water: a Wisconsin case study. Environ Monit Assess 192, 724 (2020).

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