ABSTRACT
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 (ß=0.268, P=0.013) and fluoride (ß=0.202, P=0.005) in drinking water and higher incidence of type 1 diabetes. In the regional analysis, barium (ß=-0.478, P=0.009) and nickel (ß=-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.
ABSTRACT
Psoriatic arthritis (PsA) is a chronic T cell-mediated inflammatory spondyloarthropathy affecting 10-40 % of psoriasis (PSO) patients (0.3-1.0 % of the general population). Recent epidemiological studies have shown an increased prevalence of cardiovascular (CV) risk factors and/or morbidity among PSO or PsA patients as compared to control individuals. The aim of this study is to describe the CV profile of PsA patients in Newfoundland, Canada. The possible impact of duration of chronic inflammation on CV variables was also explored. PsA patients were selected from a registry of PSO and PsA patients in Newfoundland. PsA patients diagnosed as per the CASPAR criteria are entered in the registry at the time of diagnosis, questioned on their medical history, and are followed indefinitely. Based on the duration since PsA diagnosis patients were classified as having early (<2 years) or established (≥2 years) PsA. CV risk was assessed using both conventional (hypertension, hypercholesterolemia, diabetes, obesity) and non-conventional (markers of chronic inflammation) factors. A total of 196 PsA patients were included; 42.9 % had early PsA and 57.1 % had established PsA. The prevalence of hypercholesterolemia, obesity, hypertension, diabetes mellitus, anxiety/depression, and coronary heart disease was 61.6, 59.7, 32.7, 13.8, 13.8, and 8.7 %, respectively. The prevalence of comorbidities was generally comparable between cohorts with exception of anxiety/depression, which was considerably higher in patients with established PsA compared to early PsA and obesity which was more common among male patients with established PsA. However, upon adjusting for age and gender differences, no statistically significant between-group differences were observed. Overall, these results suggest that PsA, even at early stages, is associated with significant CV comorbidity. These conditions should be taken into consideration when assessing the PsA burden of illness in epidemiological and health outcomes studies. Furthermore, early detection and management of these conditions could improve the patients' disability and quality of life.
