{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T11:42:48Z","timestamp":1791286968887,"version":"4.1.0"},"reference-count":30,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Epidemiol Community Health"],"accepted":{"date-parts":[[2015,1,18]]},"published-print":{"date-parts":[[2015,7]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>While previous research has suggested that there is an association between fluoride ingestion and the incidence of hypothyroidism, few population level studies have been undertaken. In England, approximately 10% of the population live in areas with community fluoridation schemes and hypothyroidism prevalence can be assessed from general practice data. This observational study examines the association between levels of fluoride in water supplies with practice level hypothyroidism prevalence.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We used a cross-sectional study design using secondary data to develop binary logistic regression models of predictive factors for hypothyroidism prevalence at practice level using 2012 data on fluoride levels in drinking water, 2012\/2013 Quality and Outcomes Framework (QOF) diagnosed hypothyroidism prevalence data, 2013 General Practitioner registered patient numbers and 2012 practice level Index of Multiple Deprivation scores.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Findings<\/jats:title>\n                  <jats:p>We found that higher levels of fluoride in drinking water provide a useful contribution for predicting prevalence of hypothyroidism. We found that practices located in the West Midlands (a wholly fluoridated area) are nearly twice as likely to report high hypothyroidism prevalence in comparison to Greater Manchester (non-fluoridated area).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Interpretation<\/jats:title>\n                  <jats:p>In many areas of the world, hypothyroidism is a major health concern and in addition to other factors\u2014such as iodine deficiency\u2014fluoride exposure should be considered as a contributing factor. The findings of the study raise particular concerns about the validity of community fluoridation as a safe public health measure.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/jech-2014-204971","type":"journal-article","created":{"date-parts":[[2015,2,26]],"date-time":"2015-02-26T09:33:48Z","timestamp":1424943228000},"page":"619-624","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":68,"title":["Are fluoride levels in drinking water associated with hypothyroidism prevalence in England? A large observational study of GP practice data and fluoride levels in drinking water"],"prefix":"10.1136","volume":"69","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7002-2614","authenticated-orcid":false,"given":"S","family":"Peckham","sequence":"first","affiliation":[{"name":"Centre for Health Services Studies, University of Kent, Canterbury, Kent, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D","family":"Lowery","sequence":"additional","affiliation":[{"name":"Centre for Health Services Studies, University of Kent, Canterbury, Kent, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Spencer","sequence":"additional","affiliation":[{"name":"Centre for Health Services Studies, University of Kent, Canterbury, Kent, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2015,2,24]]},"reference":[{"key":"2025100310005955000_69.7.619.1","doi-asserted-by":"crossref","first-page":"293019","DOI":"10.1155\/2014\/293019","article-title":"Water fluoridation: a critical review of the physiological effects of ingested fluoride as a public health intervention","volume":"2014","author":"Peckham","year":"2014","journal-title":"Sci World J"},{"key":"2025100310005955000_69.7.619.2","unstructured":"Public Health England. Water Fluoridation. Health monitoring report for England 2014. PHE publications gateway number: 2013547, 2014."},{"key":"2025100310005955000_69.7.619.3","unstructured":"National Research Council (NRC). Fluoride in drinking water: a scientific review of EPA's standards. Washington DC: National Academies Press, 2006."},{"key":"2025100310005955000_69.7.619.4","doi-asserted-by":"publisher","DOI":"10.1136\/jms.8.1.18"},{"key":"2025100310005955000_69.7.619.5","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(11)60276-6"},{"key":"2025100310005955000_69.7.619.6","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2006-1557"},{"key":"2025100310005955000_69.7.619.7","unstructured":"Gillam S , Siriwardena N . The quality and outcomes framework: transforming the face of primary care in the UK. Oxford: Radcliffe Publishing Ltd, 2010."},{"key":"2025100310005955000_69.7.619.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.foodres.2013.01.025"},{"key":"2025100310005955000_69.7.619.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.jfluchem.2005.09.009"},{"key":"2025100310005955000_69.7.619.10","first-page":"190","article-title":"Prenatal and postnatal ingestion of fluorides. Fourteen years of investigation\u2014final report","volume":"16","author":"Feltman","year":"1961","journal-title":"J Dent Med"},{"key":"2025100310005955000_69.7.619.11","doi-asserted-by":"publisher","DOI":"10.1210\/jcem-18-10-1102"},{"key":"2025100310005955000_69.7.619.12","unstructured":"US Public Health Services. \u201cReview of Fluoride Benefits and Risks\u201d , Table\u00a011, p. 17. 1991. http:\/\/health.gov\/environment\/ReviewofFluoride\/ (accessed 8 Jul 2014)."},{"key":"2025100310005955000_69.7.619.13","unstructured":"European Commission. Critical review of any new evidence on the hazard profile, health effects, and human exposure to fluoride and the fluoridating agents of drinking water. Scientific Committee on Health and Environmental Risks (SCHER), 2011."},{"key":"2025100310005955000_69.7.619.14","doi-asserted-by":"publisher","DOI":"10.1111\/j.1752-7325.2008.00108.x"},{"key":"2025100310005955000_69.7.619.15","doi-asserted-by":"crossref","first-page":"1135","DOI":"10.1016\/S0140-6736(72)91370-0","article-title":"Fluoride, water hardness, and endemic goitre","volume":"1","author":"Day","year":"1972","journal-title":"Lancet"},{"key":"2025100310005955000_69.7.619.16","doi-asserted-by":"publisher","DOI":"10.1038\/sj.ejcn.1600671"},{"key":"2025100310005955000_69.7.619.17","unstructured":"Larsen P , Davies T . Hypothyroidism and thyroiditis. In: Larsen P , Polonshky K . eds. Williams textbook of endocrinology. 10th edn. Philadelphia, PA: Saunders, 2002: 423\u201355."},{"key":"2025100310005955000_69.7.619.18","unstructured":"Health and Social Care Information Centre. Quality and Outcomes Framework Achievement, prevalence and exceptions data, 2012\/13. Technical Annex. October. 2013. http:\/\/www.hscic.gov.uk\/catalogue\/PUB12262\/qual-outc-fram-tech-anne-2012\u201313-anx.pdf (accessed 26 Jun 2014)."},{"key":"2025100310005955000_69.7.619.19","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1093\/bmb\/ldr030","article-title":"The epidemiology of thyroid disease","volume":"99","author":"Vanderpump","year":"2010","journal-title":"Br Med Bull"},{"key":"2025100310005955000_69.7.619.20","doi-asserted-by":"publisher","DOI":"10.1079\/BJN19940045"},{"key":"2025100310005955000_69.7.619.21","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-277X.2008.00865_1.x"},{"key":"2025100310005955000_69.7.619.22","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(11)60693-4"},{"key":"2025100310005955000_69.7.619.23","unstructured":"Office for National Statistics. Census Key Statistics (KS102EW). 2011. http:\/\/www.neighbourhood.statistics.gov.uk (accessed 22 Jul 2014)."},{"key":"2025100310005955000_69.7.619.24","unstructured":"Public Health England. National General Practice Profiles: Frequently Asked Questions. November 2013. http:\/\/www.apho.org.uk\/resource\/view.aspx?RID=96895 (accessed 16 Apr 2014)."},{"key":"2025100310005955000_69.7.619.25","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2003-032089"},{"key":"2025100310005955000_69.7.619.26","unstructured":"Drinking Water Inspectorate. Guidance on the Implementation of the Water Supply (Water Quality) Regulations 2000 (as amended) in England. Version 1.1\u2014March 2012. http:\/\/dwi.defra.gov.uk\/stakeholders\/guidance-and-codes-of-practice\/WS(WQ)-regs-england2010.pdf (accessed 18 Jun 2014)."},{"key":"2025100310005955000_69.7.619.27","unstructured":"NHS England. GP Patient Survey July 2014 CCG Report (weighted). https:\/\/gp-patient.co.uk\/surveys-and-reports (accessed 17 Jul 2014)."},{"key":"2025100310005955000_69.7.619.28","unstructured":"Blake S , Hall T , Harman M , et al . Perchlorate\u2014risks to UK drinking water sources. DEFRA 7845 (DWI70\/2\/218) Swindon. 2009."},{"key":"2025100310005955000_69.7.619.29","unstructured":"Drinking Water Inspectorate. National Tap Water Consumption Study DWI 70\/2\/217 phase two final report. 2008. http:\/\/dwi.defra.gov.uk\/research\/completed-research\/reports\/DWI70_2_217.pdf (accessed 17 Jul 2014)."},{"key":"2025100310005955000_69.7.619.30","unstructured":"Johnson CC . The geochemistry of iodine and its application to environmental strategies for reducing the risks from iodine deficiency disorders (IDD) DfID KAR Project R7411 Commissioned Report CR\/03\/057N. http:\/\/nora.nerc.ac.uk\/10724\/1\/CR03057N.pdf (accessed 4 Nov 2014)."}],"container-title":["Journal of Epidemiology and Community Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/jech-2014-204971","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T17:01:11Z","timestamp":1759510871000},"score":1,"resource":{"primary":{"URL":"https:\/\/jech.bmj.com\/lookup\/doi\/10.1136\/jech-2014-204971"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,2,24]]},"references-count":30,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2015,6,10]]},"published-print":{"date-parts":[[2015,7]]}},"alternative-id":["10.1136\/jech-2014-204971"],"URL":"https:\/\/doi.org\/10.1136\/jech-2014-204971","relation":{},"ISSN":["0143-005X","1470-2738"],"issn-type":[{"value":"0143-005X","type":"print"},{"value":"1470-2738","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,2,24]]}}}