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Shu-Li Wang,^1,2 Jeng-Min Chiou,³ Chien-Jen Chen,⁴ Chin-Hsiao Tseng,⁵ Wei-Ling Chou,¹ Cheng-Chung Wang,⁶ Trong-Neng Wu,⁷ and Louis W. Chang¹

¹Division of Environmental Health and Occupational Medicine, National Health Research Institutes, Kaohsiung, Taiwan; ²Graduate Institute of Public Health, National Cheng Kung University, Tainan City, Taiwan; ³Division of Biostatistics and Bioinformatics, National Health Research Institutes, Taipei, Taiwan; ⁴Graduate Institute of Epidemiology, College of Public Health, National Taiwan University, Taipei, Taiwan; ⁵Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; ⁶Hsin-Ying Branch Hospital, Department of Health, Tainan, Taiwan; ⁷Institute of Occupational Safety and Health, Koahsiung Medical University, Koahsiung, Taiwan

Abstract

There is evidence indicating that ingestion of arsenic may predispose the development of diabetes mellitus in arsenic-endemic areas in Taiwan. However, the prevalence of diabetes and related vascular diseases in the entire southwestern arseniasis-endemic and nonendemic areas remains to be elucidated. We used the National Health Insurance Database for 1999-2000 to derive the prevalence of non-insulin-dependent diabetes and related vascular diseases by age and sex among residents in southwestern arseniasis-endemic and nonendemic areas in Taiwan. The study included 66,667 residents living in endemic areas and 639,667 in nonendemic areas, all 25 years of age. The status of diabetes and vascular diseases was ascertained through disease diagnosis and treatment prescription included in the reimbursement claims of clinics and hospitals. The prevalence of non-insulin-dependent diabetes, age- and gender-adjusted to the general population in Taiwan, was 7.5% (95% confidence interval, 7.4-7.7%) in the arseniasis-endemic areas and 3.5% (3.5-3.6%) in the nonendemic areas. Among both diabetics and nondiabetics, higher prevalence of microvascular and macrovascular diseases was observed in arseniasis-endemic than in the nonendemic areas. Age- and gender-adjusted prevalence of microvascular disease in endemic and nonendemic areas was 20.0% and 6.0%, respectively, for diabetics, and 8.6% and 1.0%, respectively, for nondiabetics. The corresponding prevalence of macrovascular disease was 25.3% and 13.7% for diabetics, and 12.3% and 5.5% for nondiabetics. Arsenic has been suggested to increase the risk of non-insulin-dependent diabetes mellitus and its related micro- and macrovascular diseases. Key words: arsenic, diabetic complications, environmental health, epidemiology, health insurance, non-insulin-dependent diabetes mellitus, vascular diseases. Environ Health Perspect 111:155-159 (2003) . doi:10.1289/ehp.5457 available via http://dx.doi.org/ [Online 31 October 2002]