Arsenic exposure and incidence of type 2 diabetes in southwestern American Indians

Nan Hee Kim, Clinton C. Mason, Robert G. Nelson, Scott E. Afton, Amal S. Essader, James E. Medlin, Keith E. Levine, Jane A. Hoppin, Cynthia Lin, William C. Knowler, Dale P. Sandler

Research output: Contribution to journalArticlepeer-review

51 Citations (Scopus)


Association of urinary arsenic concentration with incident diabetes was examined in American Indians from Arizona who have a high prevalence of type 2 diabetes and were screened for diabetes between 1982 and 2007. The population resides where drinking water contains arsenic at concentrations above federally recommended limits. A total of 150 nondiabetic subjects aged ≥25 years who subsequently developed type 2 diabetes were matched by year of examination and sex to 150 controls who remained nondiabetic for ≥10 years. Total urinary arsenic concentration, adjusted for urinary creatinine level, ranged from 6.6 μg/L to 123.1 μg/L, and inorganic arsenic concentration ranged from 0.1 μg/L to 36.0 μg/L. In logistic regression models adjusted for age, sex, body mass index, and urinary creatinine level, the odds ratios for incident diabetes were 1.11 (95% confidence interval (CI): 0.79, 1.57) and 1.16 (95% CI: 0.89, 1.53) for a 2-fold increase in total arsenic and inorganic arsenic, respectively. Categorical analyses suggested a positive relationship between quartiles of inorganic arsenic and incident diabetes (P = 0.056); post-hoc comparison of quartiles 2-4 with quartile 1 revealed 2-fold higher odds of diabetes in the upper quartiles (OR = 2.14, 95% CI: 1.19, 3.85). Modestly elevated exposure to inorganic arsenic may predict type 2 diabetes in American Indians. Larger studies that include measures of speciated arsenic are required for confirmation.

Original languageEnglish
Pages (from-to)962-969
Number of pages8
JournalAmerican journal of epidemiology
Issue number9
Publication statusPublished - 2013 May 1
Externally publishedYes


  • Indians, North American
  • arsenic
  • diabetes mellitus, type 2
  • incidence
  • nested case-control studies

ASJC Scopus subject areas

  • Medicine(all)


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