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. 2014 Oct;122(10):1059-65.
doi: 10.1289/ehp.1408198. Epub 2014 Jun 13.

Long-term exposure to low-level arsenic in drinking water and diabetes incidence: a prospective study of the diet, cancer and health cohort

Elvira Vaclavik Bräuner  1 , Rikke Baastrup Nordsborg, Zorana Jovanovic Andersen, Anne Tjønneland, Steffen Loft, Ole Raaschou-Nielsen
Affiliations

Long-term exposure to low-level arsenic in drinking water and diabetes incidence: a prospective study of the diet, cancer and health cohort

Elvira Vaclavik Bräuner et al. Environ Health Perspect. 2014 Oct.

Abstract

Background: Established causes of diabetes do not fully explain the present epidemic. High-level arsenic exposure has been implicated in diabetes risk, but the effect of low-level arsenic exposure in drinking water remains unclear.

Objective: We sought to determine whether long-term exposure to low-level arsenic in drinking water in Denmark is associated with an increased risk of diabetes using a large prospective cohort.

Methods: During 1993-1997, we recruited 57,053 persons. We followed each cohort member for diabetes occurrence from enrollment until 31 December 2006. We traced and geocoded residential addresses of the cohort members and used a geographic information system to link addresses with water-supply areas. We estimated individual exposure to arsenic using all addresses from 1 January 1971 until the censoring date. Cox proportional hazards models were used to model the association between arsenic exposure and diabetes incidence, separately for two definitions of diabetes: all cases and a more strict definition in which cases of diabetes based solely on blood glucose results were excluded.

Results: Over a mean follow-up period of 9.7 years for 52,931 eligible participants, there were a total of 4,304 (8.1%) diabetes cases, and 3,035 (5.8%) cases of diabetes based on the more strict definition. The adjusted incidence rate ratios (IRRs) per 1-μg/L increment in arsenic levels in drinking water were as follows: IRR = 1.03 (95% CI: 1.01, 1.06) and IRR = 1.02 (95% CI: 0.99, 1.05) for all and strict diabetes cases, respectively.

Conclusions: Long-term exposure to low-level arsenic in drinking water may contribute to the development of diabetes.

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Conflict of interest statement

The authors declare they have no actual or potential competing financial interests.

Figures

Figure 1
Figure 1
Arsenic concentrations for each utility in Denmark were calculated based on 4,954 compulsory measurements taken by 2,487 water utilities (1984–2004).
Figure 2
Figure 2
Distribution of TWA concentrations of arsenic from 1971 to the end of follow-up, stratified according to enrollment area of cohort participants. (A) Copenhagen (n = 39,698); mean (minimum–maximum) = 0.76 (0.05–11.0) μg/L; median (5th–95th percentile) = 0.58 (0.22–1.78) μg/L. (B) Aarhus (n = 16,233); mean (minimum–maximum) = 2.23 (0.09–25.3) μg/L; median (5th–95th percentile) = 2.11 (0.91–2.91) μg/L.
Figure 3
Figure 3
Spline functions (solid lines) between all diabetes (A) and strict diabetes (B) and average arsenic concentration at residences from 1971 on, based on fully adjusted models and cohort participants with exposure between the 1st and 99th percentiles; dashed lines indicate 95% CIs.
See this image and copyright information in PMC

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