Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Jalan P.B. Sudirman, Sudirman Denpasar Campus, Bali, Indonesia.
Department of Electrical Engineering, Engineering Faculty, Bukit Jimbaran Campus, Udayana University, Bali, Indonesia.
Environ Int. 2020 Jul;140:105603. doi: 10.1016/j.envint.2020.105603. Epub 2020 Apr 27.
Recently emerging evidence suggests an association between particulate matter less than 2.5 µm in diameter (PM) exposure and diabetes risk. However, evidence from Asia is limited. Here, we evaluated the association between PM exposure and the prevalence of diabetes mellitus in one of the most populated countries in Asia, Indonesia.
We used the 2013 Indonesia Basic Health Research, which surveyed households in 487 regencies/municipalities in all 33 provinces in Indonesia (n = 647,947). We assigned individual exposure to PM using QGIS software. Multilevel logistic regression with a random intercept based on village and cubic spline analysis were used to assess the association between PM exposure and the prevalence of diabetes mellitus. We also assessed the lower exposure at which PM has potential adverse effects.
We included 647,947 subjects with a mean age of 41.9 years in our study. Exposure to PM levels was associated with a 10-unit increase in PM (fully adjusted odds ratio: 1.09; 95% confidence interval: 1.05-1.14). The findings were consistent for quartile increases in PM levels and the cubic spline function. Even when we restricted to those exposed to PM concentrations of less than 10.0 µg/m in accordance with the recommended guidelines for annual exposure to PM made by the World Health Organization, the association remained elevated, especially among subjects living in the urban areas. Hence, we were unable to establish a safe threshold for PM and the risk of diabetes.
Our findings suggest a positive association between PM exposure and prevalence of diabetes mellitus, which is possibly below the current recommended guidelines. Further studies are needed to ascertain the causal association of this finding.
最近出现的证据表明，直径小于 2.5μm 的颗粒物（PM）暴露与糖尿病风险之间存在关联。然而，亚洲的证据有限。在这里，我们评估了 PM 暴露与亚洲人口最多的国家之一印度尼西亚的糖尿病患病率之间的关系。
我们使用了 2013 年印度尼西亚基本健康研究的数据，该研究调查了印度尼西亚 33 个省的 487 个县/市的家庭（n=647947）。我们使用 QGIS 软件为个体分配 PM 暴露量。采用基于村庄的多层逻辑回归和三次样条分析来评估 PM 暴露与糖尿病患病率之间的关系。我们还评估了 PM 潜在不良影响的较低暴露水平。
我们纳入了 647947 名年龄平均为 41.9 岁的受试者。PM 暴露与 PM 水平增加 10 个单位相关（完全调整后的比值比：1.09；95%置信区间：1.05-1.14）。PM 水平四分位增加和三次样条函数的结果一致。即使我们根据世界卫生组织推荐的 PM 年暴露浓度指南，将研究对象限制在暴露于 PM 浓度低于 10.0μg/m 的范围内，这种关联仍然存在，尤其是在居住在城市地区的人群中。因此，我们无法确定 PM 与糖尿病风险之间的安全阈值。
我们的研究结果表明，PM 暴露与糖尿病患病率之间存在正相关关系，这可能低于目前推荐的指南。需要进一步的研究来确定这一发现的因果关系。
