Evaluation of heavy metal exposure and health among Appalachian groundwater users

A variety of health conditions have been observed with greater frequency in the Central Appalachian region than all other regions of the United States. Many diseases are linked to social/behavioral factors; however researchers also suspect potential environmental determinants. Despite elevated metal concentrations in some Eastern Kentucky groundwater samples, no peer-reviewed epidemiological studies have evaluated the association between metal exposures and health effects in this population. For addressing this problem, we performed a cross-sectional study on 194 households (n = 381 household members) in southeast Kentucky. Water samples and health data were obtained. Samples were evaluated for metals, including arsenic, manganese, lead, iron, and aluminum. The orally-administered health questionnaire ascertained self-reported information not limited to kidney and liver problems, cancer, neurological signs, diabetes, mental disability, female reproductive health, and blood pressure. Additional data on potential confounders (e.g., age, height, weight, smoking status, etc.) were obtained. Manganese levels exceeded World Health Organization standards in 7% of samples. Arsenic and lead exceeded U.S. EPA primary drinking standards in 3% and 11% of samples, respectively. Among women 14 years of age or older, 29% reported a lost baby during pregnancy or within one year of birth. No association between water quality and losing a baby was observed. Diabetes was observed in 13% of participants.  Upon adjusting for BMI, age, and gender, increasing concentrations of manganese (mg/L) were associated with increased odds of diabetes (OR = 3.1; 95% C.I. 1.4 – 6.3).  Elevated frequencies of other health conditions were observed and additional studies are warranted.