Key Laboratory of Cardiovascular Epidemiology & Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
Environ Int. 2019 May;126:568-575. doi: 10.1016/j.envint.2019.02.069. Epub 2019 Mar 7.
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 PM concentrations.
A cohort-based study was conducted to assess the diabetes incidence associated with long-term exposure to ambient PM.
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 PM exposures were estimated from satellite-based PM 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 PM, 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/m in long-term PM 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 PM were larger among females, rural subjects, non-smokers, normotensives, subjects younger than 65 years and subjects with body mass index <25 kg/m.
Our findings provided evidence for the association of long-term exposure to PM with diabetes incidence in China. A sustained improvement of air quality will benefit the reduction for diabetes epidemic in China.
糖尿病在全球范围内造成了巨大的经济和健康负担。然而，在发展中国家，空气污染与糖尿病发病率之间的关联很少有报道，尤其是在中国，其 PM 浓度相对较高。
本队列研究旨在评估长期暴露于环境 PM 与糖尿病发病率之间的关系。
我们从中国的预测动脉粥样硬化性心血管疾病风险项目（China-PAR 项目）的 15 个省份收集了个体健康数据和危险因素。糖尿病的定义为随访时空腹血糖水平≥7.0mmol/L，或使用胰岛素或口服降糖药，或在 2004 年至 2015 年期间被诊断患有糖尿病。个体水平的 PM 暴露量是根据研究期间基于卫星的 PM 浓度（10km 空间分辨率）来估算的。采用具有每个队列和地区随机截距的 Cox 比例风险模型，在调整年龄、性别、体重指数、吸烟状况、教育程度、与工作相关的体力活动水平、高血压、城市化程度、县级平均受教育年限以及长期温度和相对湿度水平后，估计 PM 导致的糖尿病发病率。
在 2004 年后共分析了 88397 名受试者，随访 580928 人年，共观察到 6439 例新的糖尿病病例。受试者的平均年龄为 51.7 岁。对于长期 PM 暴露增加 10μg/m，多变量调整后的糖尿病发病率百分比增加估计为 15.66%（95%置信区间：6.42%，25.70%）。PM 的不良影响在女性、农村居民、非吸烟者、血压正常者、年龄小于 65 岁者和 BMI<25kg/m 者中更大。
本研究结果为中国长期暴露于 PM 与糖尿病发病率之间的关联提供了证据。持续改善空气质量将有利于减少中国的糖尿病流行。
