Objective To determine the association between drinking water quality and rates of type 1 diabetes in the Newfoundland and Labrador (NL) population, which has one of the highest incidences of type 1 diabetes reported globally.
Research design and methods The study used a community-based, case-control design. We first calculated incidence rates of type 1 diabetes at the provincial, regional and community levels. The connection between incidence rates and components in public water supplies were then analyzed in three ways: to evaluate differences in water quality between communities with and without incident cases of type 1 diabetes, and to analyze the relationship between water quality and incidence rates of type 1 diabetes at both the community and regional levels.
Results The provincial incidence of type 1 diabetes was 51.7/100 000 (0-14 year age group) for the period studied. In the community-based analysis, there were significant associations found between higher concentrations of arsenic (β=0.268, P=0.013) and fluoride (β=0.202, P=0.005) in drinking water and higher incidence of type 1 diabetes. In the regional analysis, barium (β=−0.478, P=0.009) and nickel (β=−0.354, P=0.050) concentrations were negatively associated with incidence of type 1 diabetes.
Conclusions We confirmed the high incidence of type 1 diabetes in NL. We also found that concentrations of some components in drinking water were associated with higher incidence of type 1 diabetes, but no component was found to have a significant association across the three different levels of analysis performed.
- type 1 diabetes mellitus
- Newfoundland and Labrador
- drinking water quality
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Contributors RC contributed to the design of the study, was involved in the interpretation of the data and contributed to the writing of the manuscript. RA analyzed and interpreted the data and contributed to the manuscript. AS contributed to the study design, literature review and manuscript plan including editing. PG and AC researched and collected data, developed and maintained the dataset. LAN contributed to the design of the study, was involved in the interpretation of the data and contributed to the writing of the manuscript. All authors approve of the version of the manuscript submitted. LAN is the guarantor of this work and takes responsibility for the integrity of the data and its interpretation.
Funding This research was supported by grants from the Janeway Hospital Research Foundation and the Leslie Harris Centre RBC drinking water and outreach research fund, Memorial University.
Competing interests None declared.
Ethics approval This study was approved by Newfoundland and Labrador ’s Health Research Ethics Authority (2013; HREB #2013.172).
Data sharing statement Data is stored at the Janeway Pediatric Research Unit as per HREB requirements.
Presented at A report outlining initial findings from ’The association of type 1 diabetes mellitus and drinking water contamination in Newfoundland and Labrador - literature review' project was presented and submitted to the Leslie Harris Centre of regional policy and development in Memorial University of Newfoundland in October 2015 44.
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