title: Arsenic in drinking water and cerebrovascular disease, diabetes mellitus, and kidney disease in Michigan: a standardized mortality ratio analysis.
abstract: BACKGROUND
  Exposure to arsenic concentrations in drinking water in excess of 300 microg/L is associated with diseases of the circulatory and respiratory system, several types of cancer, and diabetes; however, little is known about the health consequences of exposure to low-to-moderate levels of arsenic (10-100 microg/L).
  
  
  METHODS
  A standardized mortality ratio (SMR) analysis was conducted in a contiguous six county study area of southeastern Michigan to investigate the relationship between moderate arsenic levels and twenty-three selected disease outcomes. Disease outcomes included several types of cancer, diseases of the circulatory and respiratory system, diabetes mellitus, and kidney and liver diseases. Arsenic data were compiled from 9251 well water samples tested by the Michigan Department of Environmental Quality from 1983 through 2002. Michigan Resident Death Files data were amassed for 1979 through 1997 and sex-specific SMR analyses were conducted with indirect adjustment for age and race; 99% confidence intervals (CI) were reported.
  
  
  RESULTS
  The six county study area had a population-weighted mean arsenic concentration of 11.00 microg/L and a population-weighted median of 7.58 microg/L. SMR analyses were conducted for the entire six county study area, for only Genesee County (the most populous and urban county), and for the five counties besides Genesee. Concordance of results across analyses is used to interpret the findings. Elevated mortality rates were observed for both males (M) and females (F) for all diseases of the circulatory system (M SMR, 1.11; CI, 1.09-1.13; F SMR, 1.15; CI, 1.13,-1.17), cerebrovascular diseases (M SMR, 1.19; CI, 1.14-1.25; F SMR, 1.19; CI, 1.15-1.23), diabetes mellitus (M SMR, 1.28; CI, 1.18-1.37; F SMR, 1.27; CI, 1.19-1.35), and kidney diseases (M SMR, 1.28; CI, 1.15-1.42; F SMR, 1.38; CI, 1.25-1.52).
  
  
  CONCLUSIONS
  This is some of the first evidence to suggest that exposure to low-to-moderate levels of arsenic in drinking water may be associated with several of the leading causes of mortality, although further epidemiologic studies are required to confirm the results suggested by this ecologic SMR analysis.
authors.affiliation: BioMedware, Inc, Ann Arbor, Michigan, USA. meliker@biomedware.com
authors.forename: Jaymie R
authors.initials: JR
authors.lastname: Meliker
authors.forename: Robert L
authors.initials: RL
authors.lastname: Wahl
authors.forename: Lorraine L
authors.initials: LL
authors.lastname: Cameron
authors.forename: Jerome O
authors.initials: JO
authors.lastname: Nriagu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001151:Arsenic / Q000009:adverse effects*; D002561:Cerebrovascular Disorders / Q000209:etiology / Q000401:mortality*; D003920:Diabetes Mellitus / Q000209:etiology / Q000401:mortality*; D016021:Epidemiologic Studies; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000209:etiology / Q000401:mortality*; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D018570:Risk Assessment; D014881:Water Supply
chemical_list: D001151:Arsenic