A case-cohort study examining lifetime exposure to inorganic arsenic in drinking water and diabetes mellitus

• Published in: Environmental research Vol. 123; pp. 33 - 38
• Main Authors: James, Katherine A., Marshall, Julie A., Hokanson, John E., Meliker, Jaymie R., Zerbe, Gary O., Byers, Tim E.
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Inc 01.05.2013; Elsevier
• Subjects: Adult; Aged; Arsenic; Arsenic - administration & dosage; Arsenic - adverse effects; Assessments; Biological and medical sciences; Carcinogenesis, carcinogens and anticarcinogens; Chemical agents; Chemical and industrial products toxicology. Toxic occupational diseases; Colorado - epidemiology; Diabetes mellitus; Diabetes Mellitus, Type 2 - epidemiology; Diabetes Mellitus, Type 2 - etiology; Diabetes. Impaired glucose tolerance; Drinking Water; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Estimates; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Exposure; Female; Geospatial modeling; Hazards; Humans; Life cycle assessment; Male; Medical sciences; Metals and various inorganic compounds; Middle Aged; Prospective Studies; Risk; Risk Factors; Toxicology; Tumors; Urine; Water Pollutants, Chemical - administration & dosage; Water Pollutants, Chemical - adverse effects; Young Adult; Colorado; USA, Colorado, San Luis Valley; Urine; Drinking water; Arsenic; Diabetes mellitus; DM; HR; Geospatial modeling; GPS; IQR; GIS; SLVDS; ICP-MS; μg/L; HPLC; TWA; BMI; Endocrinopathy; Human; Biological fluid; Arsenic compound; Exposure; Case control study; Epidemiology; Modeling; Carcinogen; Public health
• ISSN: 0013-9351; 1096-0953
• DOI: 10.1016/j.envres.2013.02.005

Consumption of drinking water with high levels of inorganic arsenic (over 500μg/L) has been associated with type II diabetes mellitus (DM), but previous studies have been inconclusive about risks at lower levels (<100μg/L). We present a case-cohort study based on individual estimates of lifetime arsenic exposure to examine the relationship between chronic low-level arsenic exposure and risk of DM. This case-cohort study included 141 cases of DM diagnosed between 1984 and 1998 as part of the prospective San Luis Valley Diabetes Study. A comparison sub-cohort of 488 participants was randomly sampled from 936 eligible participants who were disease free at baseline. Individual lifetime arsenic exposure estimates were determined using a methodology that incorporates the use of a structured interview to determine lifetime residence and employment history, geospatial modeling of arsenic concentrations in drinking water, and urine arsenic concentrations. A Cox proportional hazards model with known DM risk factors as time-dependent covariates was used to assess the association between lifetime exposure to inorganic arsenic in drinking water and incident DM. Our findings show a significant association between inorganic arsenic exposure and DM risk (hazard ratio [HR]=1.27, 95%=1.01, 1.59 per 15μg/L) while adjusting for ethnicity and time varying covariates age, body mass index and physical activity level. Exposure to low-level inorganic arsenic in drinking water is associated with increased risk for type II DM in this population based on a comprehensive lifetime exposure assessment. ► We present complex lifetime exposure assessment for arsenic in drinking water. ► Our exposure assessment was validated with urinary biomarker. ► The risk for diabetes increases with exposure to arsenic in drinking water. ► The risk for diabetes with arsenic exposure is independent of known risk factors.