OBJECTIVE We examined the association of arsenic in federally regulated community water systems (CWSs) and unregulated private wells with type 2 diabetes (T2D) incidence in the Strong Heart Family Study (SHFS), a prospective study of American Indian communities, and the Multi-Ethnic Study of Atherosclerosis (MESA), a prospective study of racially and ethnically diverse urban U.S. communities. RESEARCH DESIGN AND METHODS We evaluated 1,791 participants from SHFS and 5,777 participants from MESA who had water arsenic estimates available and were free of T2D at baseline (2001–2003 and 2000–2002, respectively). Participants were followed for incident T2D until 2010 (SHFS cohort) or 2019 (MESA cohort). We used Cox proportional hazards mixed-effects models to account for clustering by family and residential zip code, with adjustment for sex, baseline age, BMI, smoking status, and education. RESULTS T2D incidence was 24.4 cases per 1,000 person-years (mean follow-up, 5.6 years) in SHFS and 11.2 per 1,000 person-years (mean follow-up, 14.0 years) in MESA. In a meta-analysis across the SHFS and MESA cohorts, the hazard ratio (95% CI) per doubling in CWS arsenic was 1.10 (1.02, 1.18). The corresponding hazard ratio was 1.09 (0.95, 1.26) in the SHFS group and 1.10 (1.01, 1.20) in the MESA group. The corresponding hazard ratio (95% CI) for arsenic in private wells and incident T2D in SHFS was 1.05 (0.95, 1.16). We observed statistical interaction and larger magnitude hazard ratios for participants with BMI <25 kg/m2 and female participants. CONCLUSIONS Low to moderate water arsenic levels (<10 µg/L) were associated with T2D incidence in the SHFS and MESA cohorts.

中文翻译：

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水砷与美国成人糖尿病发病率的关联：动脉粥样硬化的多种族研究和强心研究

目的 我们在强心家族研究 (SHFS) 中研究了联邦监管的社区供水系统 (CWS) 和不受监管的私人水井中的砷与 2 型糖尿病 (T2D) 发病率之间的关系，该研究是一项针对美洲印第安人社区的前瞻性研究，也是一项针对美国印第安人社区的前瞻性研究。动脉粥样硬化种族研究 (MESA)，一项针对美国城市社区种族和族裔多元化的前瞻性研究。研究设计和方法 我们评估了来自 SHFS 的 1,791 名参与者和来自 MESA 的 5,777 名参与者，他们有水砷估计值，并且在基线时（分别为 2001-2003 年和 2000-2002 年）没有患 T2D。对参与者的 T2D 事件进行随访直至 2010 年（SHFS 队列）或 2019 年（MESA 队列）。我们使用 Cox 比例风险混合效应模型来解释按家庭和住宅邮政编码进行的聚类，并对性别、基线年龄、体重指数、吸烟状况和教育程度进行了调整。结果 SHFS 中 T2D 发病率为每 1,000 人年 24.4 例（平均随访时间为 5.6 年），MESA 中为每 1,000 人年 11.2 例（平均随访时间为 14.0 年）。在 SHFS 和 MESA 队列的荟萃分析中，CWS 砷每次倍增的风险比 (95% CI) 为 1.10 (1.02, 1.18)。 SHFS 组相应的风险比为 1.09（0.95，1.26），MESA 组相应的风险比为 1.10（1.01，1.20）。私人井中砷和 SHFS 中 T2D 事件的相应危险比 (95% CI) 为 1.05 (0.95, 1.16)。我们观察了 BMI <25 kg/m2 的参与者和女性参与者的统计交互作用和更大的风险比。结论 SHFS 和 MESA 队列中低至中度水砷水平 (<10 µg/L) 与 T2D 发病率相关。