Icahn School of Medicine at Mount Sinai, Department of Environmental Medicine and Public Health, New York, NY, USA.
Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Environ Pollut. 2023 Mar 1;320:121056. doi: 10.1016/j.envpol.2023.121056. Epub 2023 Jan 9.
Type 2 diabetes is a major public health concern. Several studies have found an increased diabetes risk associated with long-term air pollution exposure. However, most current studies are limited in their generalizability, exposure assessment, or the ability to differentiate incidence and prevalence cases. We assessed the association between air pollution and first documented diabetes occurrence in a national U.S. cohort of older adults to estimate diabetes risk. We included all Medicare enrollees 65 years and older in the fee-for-service program, part A and part B, in the contiguous United States (2000-2016). Participants were followed annually until the first recorded diabetes diagnosis, end of enrollment, or death (264, 869, 458 person-years). We obtained annual estimates of fine particulate matter (PM), nitrogen dioxide (NO), and warm-months ozone (O) exposures from highly spatiotemporally resolved prediction models. We assessed the simultaneous effects of the pollutants on diabetes risk using survival analyses. We repeated the models in cohorts restricted to ZIP codes with air pollution levels not exceeding the national ambient air quality standards (NAAQS) during the study period. We identified 10, 024, 879 diabetes cases of 41, 780, 637 people (3.8% of person-years). The hazard ratio (HR) for first diabetes occurrence was 1.074 (95% CI 1.058; 1.089) for 5 μg/m increase in PM 1.055 (95% CI 1.050; 1.060) for 5 ppb increase in NO, and 0.999 (95% CI 0.993; 1.004) for 5 ppb increase in O. Both for NO and PM there was evidence of non-linear exposure-response curves with stronger associations at lower levels (NO ≤ 36 ppb, PM ≤ 8.2 μg/m). Furthermore, associations remained in the restricted low-level cohorts. The O-diabetes exposure-response relationship differed greatly between models and require further investigation. In conclusion, exposures to PM and NO are associated with increased diabetes risk, even when restricting the exposure to levels below the NAAQS set by the U.S. EPA.
2 型糖尿病是一个主要的公共卫生问题。多项研究发现，长期暴露于空气污染与糖尿病风险增加有关。然而，大多数现有研究在其普遍性、暴露评估或区分发病率和患病率方面存在局限性。我们评估了空气污染与美国老年人群队列中首次记录的糖尿病发生之间的关联，以估计糖尿病风险。我们纳入了医疗保险费制计划（Part A 和 Part B）中所有在美国连续地区的 65 岁及以上的参保者（2000-2016 年）。参与者每年随访一次，直到首次记录糖尿病诊断、入组结束或死亡（264,869,458 人年）。我们从高度时空分辨率预测模型中获得了每年细颗粒物（PM）、二氧化氮（NO）和暖季臭氧（O）暴露的估计值。我们使用生存分析评估了污染物对糖尿病风险的综合影响。我们在研究期间空气污染水平未超过国家环境空气质量标准（NAAQS）的邮政编码队列中重复了这些模型。我们确定了 10,024,879 例糖尿病病例，涉及 41,780,637 人（3.8%的人年）。PM 每增加 5μg/m，首次发生糖尿病的风险比（HR）为 1.074（95%CI 1.058；1.089）；NO 每增加 5ppb，HR 为 1.055（95%CI 1.050；1.060）；O 每增加 5ppb，HR 为 0.999（95%CI 0.993；1.004）。NO 和 PM 均存在非线性暴露-反应曲线的证据，在较低水平下关联更强（NO≤36 ppb，PM≤8.2μg/m）。此外，在低水平限制队列中，相关性仍然存在。O-糖尿病暴露-反应关系在不同模型之间差异很大，需要进一步研究。总之，即使将暴露限制在美国环保署设定的 NAAQS 以下水平，PM 和 NO 的暴露仍与糖尿病风险增加有关。
