Department of Environmental Medicine, New York University School of Medicine, 57 Old Forge Rd, Tuxedo Park, NY 10987, USA.
Department of Environmental Medicine, New York University School of Medicine, 57 Old Forge Rd, Tuxedo Park, NY 10987, USA; Department of Population Health, New York University School of Medicine, USA.
Environ Res. 2018 Aug;165:330-336. doi: 10.1016/j.envres.2018.04.011. Epub 2018 May 17.
Recent mechanistic and epidemiological evidence implicates air pollution as a potential risk factor for diabetes; however, mortality risks have not been evaluated in a large US cohort assessing exposures to multiple pollutants with detailed consideration of personal risk factors for diabetes.
We assessed the effects of long-term ambient air pollution exposures on diabetes mortality in the NIH-AARP Diet and Health Study, a cohort of approximately a half million subjects across the contiguous U.S. The cohort, with a follow-up period between 1995 and 2011, was linked to residential census tract estimates for annual mean concentration levels of PM, NO, and O. Associations between the air pollutants and the risk of diabetes mortality (N = 3598) were evaluated using multivariate Cox proportional hazards models adjusted for both individual-level and census-level contextual covariates.
Diabetes mortality was significantly associated with increasing levels of both PM (HR = 1.19; 95% CI: 1.03-1.39 per 10 μg/m) and NO (HR = 1.09; 95% CI: 1.01-1.18 per 10 ppb). The strength of the relationship was robust to alternate exposure assessments and model specifications. We also observed significant effect modification, with elevated mortality risks observed among those with higher BMI and lower levels of fruit consumption.
We found that long-term exposure to PM and NO, but not O, is related to increased risk of diabetes mortality in the U.S, with attenuation of adverse effects by lower BMI and higher fruit consumption, suggesting that air pollution is involved in the etiology and/or control of diabetes.
最近的机制和流行病学证据表明，空气污染可能是糖尿病的一个潜在风险因素；然而，在一个评估多种污染物暴露情况的大型美国队列中，尚未对死亡率风险进行评估，且该队列对糖尿病个人风险因素进行了详细考虑。
我们评估了长期环境空气污染暴露对 NIH-AARP 饮食与健康研究中糖尿病死亡率的影响，该研究是一个在美国各地的近 50 万参与者的队列。该队列的随访时间为 1995 年至 2011 年，与居住在人口普查区的年度平均浓度水平的 PM、NO 和 O 进行了联系。使用多变量 Cox 比例风险模型评估了空气污染物与糖尿病死亡率风险之间的关系（N=3598），该模型同时调整了个体水平和人口普查水平的上下文协变量。
糖尿病死亡率与 PM（HR=1.19；95%CI：每 10μg/m 增加 1.03-1.39）和 NO（HR=1.09；95%CI：每 10ppb 增加 1.01-1.18）水平的升高显著相关。这种关系的强度在替代暴露评估和模型规范中是稳健的。我们还观察到了显著的效应修饰，在 BMI 较高和水果摄入量较低的人群中，死亡率风险升高。
我们发现，长期暴露于 PM 和 NO，但不是 O，与美国糖尿病死亡率的增加有关，而 BMI 较低和水果摄入量较高可减轻不良影响，这表明空气污染与糖尿病的病因和/或控制有关。
