Western College of Veterinary Medicine, University of Saskatchewan, 52 Campus Drive, Saskatoon, SK, S7N 5B4, Canada.
School of Public Health, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK, S7N 2Z4, Canada.
Arch Environ Contam Toxicol. 2019 Apr;76(3):375-393. doi: 10.1007/s00244-018-00588-4. Epub 2019 Jan 7.
There is growing interest in the role of environmental exposures in the development of diabetes. Previous studies in rural Saskatchewan have raised concerns over drinking water contaminants, including arsenic, which has been identified as a possible risk factor for diabetes. Using administrative health and water-quality surveillance data from rural Saskatchewan, an ecological study design was used to investigate associations between concentrations of arsenic, water health standards and aesthetic objectives, and the incidence and prevalence of diabetes. Mixtures of contaminants measured as health standards or as aesthetic objectives were summarized using principal component (PC) analysis. Associations were modeled using Bayesian hierarchical models incorporating both spatial and unstructured random effects, standardized for age and sex, and adjusted for socioeconomic factors and a surrogate measure for smoking rates. Arsenic was not associated with an increased risk of diabetes. For private wells, having groundwater arsenic concentrations in the highest quintile was associated with decreased cumulative diabetes incidence for 2010-2012 (risk ratio [RR] = 0.854, 95% credible interval [CrI] 0.761-0.958) compared with the lowest quintile, a result inconsistent with other studies. For public water supplies, having a first PC score for health standards (primarily summarized selenium, nitrate, and lead) in the third quintile (RR = 1.101, 95% CrI 1.019-1.188), fourth quintile (RR = 1.088, 95% CrI 1.003-1.180), or fifth quintile (RR = 1.115, 95% CrI 1.026-1.213) was associated with an increase in 2010 diabetes prevalence compared with the first quintile. An increase in the PC scores for the third aesthetic objective in private wells (characterized primarily by iron and manganese) was associated with decreased diabetes incidence, although a meaningful dose-response relationship was not evident. No other associations between PC scores for health standards or aesthetic objectives from public or private water supplies and diabetes were identified.
人们对环境暴露在糖尿病发展中的作用越来越感兴趣。萨斯喀彻温省农村地区的先前研究引起了对饮用水污染物的关注，其中包括砷，砷已被确定为糖尿病的一个潜在危险因素。本研究使用萨斯喀彻温省农村地区的行政健康和水质监测数据，采用生态研究设计，调查了砷浓度、水健康标准和美学目标与糖尿病发病率和患病率之间的关联。使用主成分 (PC) 分析对作为健康标准或美学目标测量的污染物混合物进行了总结。使用贝叶斯层次模型对关联进行建模，该模型结合了空间和非结构化随机效应，按年龄和性别进行了标准化，并调整了社会经济因素和吸烟率的替代指标。砷与糖尿病风险增加无关。对于私人水井，地下水砷浓度最高的五分位数与 2010-2012 年累积糖尿病发病率降低有关（风险比 [RR] = 0.854，95%置信区间 [CrI] 0.761-0.958），与最低五分位数相比，这一结果与其他研究不一致。对于公共供水，健康标准的第一 PC 得分（主要总结为硒、硝酸盐和铅）处于第三五分位数（RR = 1.101，95% CrI 1.019-1.188）、第四五分位数（RR = 1.088，95% CrI 1.003-1.180）或第五五分位数（RR = 1.115，95% CrI 1.026-1.213）时，2010 年糖尿病患病率与第一五分位数相比有所增加。私人水井中第一美学目标 PC 得分（主要由铁和锰决定）的增加与糖尿病发病率的降低有关，尽管没有明显的剂量反应关系。没有发现公共或私人供水的健康标准或美学目标的 PC 得分与糖尿病之间的其他关联。
