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Long-term exposure to ambient fine particulate matter and incidence of diabetes in China: A cohort study

Liang, Fengchao, Yang, Xueli, Liu, Fangchao, Li, Jianxin, Xiao, Qingyang, Chen, Jichun, Liu, Xiaoqing, Cao, Jie, Shen, Chong, Yu, Ling, Lu, Fanghong, Wu, Xianping, Zhao, Liancheng, Wu, Xigui, Li, Ying, Hu, Dongsheng, Huang, Jianfeng, Liu, Yang, Lu, Xiangfeng, Gu, Dongfeng
Environment international 2019 v.126 pp. 568-575
adverse effects, air pollution, air quality, body mass index, chronic exposure, cohort studies, confidence interval, developing countries, diabetes, education, females, glucose, hypertension, hypoglycemic agents, insulin, medical history, models, particulates, physical activity, prediction, risk factors, satellites, smoking (habit), temperature, China
Diabetes caused substantial economic and health burden worldwide. However, the associations between air pollution and diabetes incidence were rarely reported in the developing countries, especially in China with relatively high PM₂.₅ concentrations.A cohort-based study was conducted to assess the diabetes incidence associated with long-term exposure to ambient PM₂.₅.We collected individual health data and risk factors from the project of Prediction for Atherosclerotic Cardiovascular Disease Risk in China (China-PAR Project) from 15 provinces over China. Diabetes was defined as fasting glucose levels ≥7.0 mmol/L at the follow-ups and/or the use of insulin or oral hypoglycemic agents and/or diagnosed medical history of diabetes during 2004 to 2015. Individual-level PM₂.₅ exposures were estimated from satellite-based PM₂.₅ concentrations (10 km spatial resolution) during the study period. Cox proportional hazards models with random intercepts of each cohort and region were employed to estimate the diabetes incidence attributable to PM₂.₅, after the adjustment for age, gender, body mass index, smoking status, education, work-related physical activity level, hypertension, urbanicity, county-level averaged years of education, and long-term levels of temperature and relative humidity.A total of 88,397 subjects were analyzed with 580,928 person-years of follow-up after 2004, among which 6439 new cases of diabetes were observed. The mean age of the subjects was 51.7 years at baseline. For an increase of 10 μg/m³ in long-term PM₂.₅ exposure, the multivariable-adjusted percent increase in the diabetes incidence was estimated to be 15.66% (95% confidence interval: 6.42%, 25.70%). The adverse effects of PM₂.₅ were larger among females, rural subjects, non-smokers, normotensives, subjects younger than 65 years and subjects with body mass index <25 kg/m².Our findings provided evidence for the association of long-term exposure to PM₂.₅ with diabetes incidence in China. A sustained improvement of air quality will benefit the reduction for diabetes epidemic in China.