Table 5:

Studies from Latin American countries showing association between arsenic exposure and chronic diseases (cardiopulmonary health outcomes and diabetes)

Reference	Country	Design	Characteristics of subjects	Results/ Main Findings
Dauphine et al. (2011)	Chile	Cross-sectional	32 adults exposed to high As (As) (>800 μg/L before age 10) and 65 adults without high early-life exposure	Exposure to early-life As showed significant associations with 11.5% lower FEV1 (p= 0.04), 12.2% lower FVC (p = 0.04), and increased breathlessness (prevalence odds ratio (OR) = 5.94, 95% CI: 1.36, 26.0)
Del Razo et al. (2011)	Mexico	Cross-sectional	147 subjects from Zimapán and 111 from Lagunera of both sexes and ≥ 5 years were recruited.	Positive association between diabetes and iAs in drinking water (OR 1.13 per 10 μg/L, p < 0.01) and with DMA concentration in urine (OR 1.24 per inter-quartile range, p = 0.05) was observed
Roman et al. (2011)	Chile	Cross-sectional	215 As-exposed patients of coronary heart diseases (CHD) and 25 As-unexposed patients of CHD	Significant difference between As-exposed and unexposed patients for As concentrations in auricle and mammary artery tissues
Smith et al. (2011)	Chile	Ecological	Mortality data for the two regions were obtained for 1958–2000.	The peak 5-year TB mortality rate ratio (RR) in men during 1982–1986 was RR = 2.1, 95% CI: 1.7, 2.6; p < 0.001, followed by a decline. Mortality rates in women showed less excess pulmonary TB deaths
Burgess et al. (2013)	Mexico	Cross-sectional	215 adult residents from Arizona, USA and 163 from Sonora, Mexico	Drinking water As concentration and intake showed positive association with MMP-9, in crude analysis and after adjustment. On multivariable analysis, urinary As sum of species showed positive association with MMP-9
Diaz-Villasenor et al. (2013)	Mexico	Cross-sectional	40 Type 2 diabetic subjects and 32 non-diabetic matched subjects	Subjects with Type 2 diabetes mellitus (T2DM) had significantly lower beta cell function and insulin sensitivity. Beta cell function was inversely associated (pronounced in T2DM subjects) with iAs exposure. This association was enhanced in the presence of SNP-43 in CAPN-10
Currier et al. (2014)	Mexico	Cross-sectional	374 adults with ≥ 5 years of uninterrupted residency in the study area	Interquartile range increase in trivalent As species in EUC had positive and significant association with diabetes, (ORs=1.57; 95% CI: 1.19, 2.07 for iAsIII, OR=1.63; 95% CI; 1.24, 2.15 for MAsIII, and OR=1.31; 95% CI: 0.96, 1.84 for DMAsIII
Martin et al. (2015)	Mexico	Cross-sectional	90 diabetic and 86 nondiabetic matched individuals enrolled in Chihuahua As cohort	iAs exposed diabetic subjects had 59 altered metabolites including those related to tricarboxylic acid cycle and amino acid metabolism
Mendez et al. (2016)	Mexico	Cross-sectional	1,160 adults with a minimum 5-year uninterrupted residency in the study area	Second quartile of water As (25.5 to < 47.9 μg/L) and total speciated urinary As (< 55.8 μg/L) below the median were significantly associated with elevated triglycerides, high total cholesterol, and diabetes
Sandoval-Carrillo et al. (2016)	Mexico	Case-control	104 preeclamptic cases and 202 healthy pregnant women as controls	No significant difference in As exposure between cases and controls.
Steinmaus et al. (2016)	Chile	Cross-sectional	204, 208, and 383 people exposed to water As <11 μg/L, 11–200 μg/L and >200 μg/L respectively	Adults born in the high exposure period had elevated OR for shortness of breath = 5.56, 90% CI: 2.68, 11.5, and decreases in pulmonary function (224 mL decrease in FVC in nonsmokers, 90% CI: 97, 351 mL) than adults never exposed to >10 μg/L
Hall et al. (2017)	Chile	Case-control	665 newly diagnosed cancer cases and 640 cancer free controls	Subjects in the 60–623μg/L and >623μg/L exposure categories had adjusted hypertension ORs of 1.49 (95% CI: 1.09, 2.05) and 1.65 (95% CI: 1.18, 2.32) respectively when compared with the lowest category (<60μg/L)
Nardone et al. (2017)	Chile	Cross-sectional	751 adults	Adults with BMI > 90th percentile (> 33.9 kg/m2) and water As concentrations ≥11 μg/L had ORs for cough (OR = 10.7, 95% CI: 3.03, 50.1), shortness of breath (OR = 14.2, 95% CI: 4.79, 52.4), wheeze (OR = 14.4, 95% CI: 4.80, 53.7), and any respiratory symptom (OR = 9.82, 95% CI: 4.22, 24.5)
Castriota et al. (2018)	Chile	Case-control	234 diabetic patients and 819 subjects without known diabetes	Cumulative As exposure group 610–5279 and ≥ 5280 μg/L-years had OR=0.97 (95% CI: 0.66, 1.43) and 1.53 (95% CI: 1.05, 2.23) respectively for T2D. The OR for ≥ 5280 μg/L-years =1.45 (95% CI: 0.74, 2.84) in participants with BMIs < 25 kg/m2 and OR =2.64 (95% CI: 1.14, 6.11) for BMIs ≥ 30 kg/m2 (synergy index = 2.49, 95% CI: 0.87, 7.09)
Munoz et al. (2018)	Chile	Cross-sectional	244 pregnant women	No significant associations were found between gestational diabetes and iAs exposure tertiles. Tertile 2:OR= 2.98, 95% CI: 0.87, 10.18, Tertile 3:OR=1.07, 95% CI: 0.26, 4.33