Weiss Margaret C, Adusumilli Sneha, Jagai Jyotsna S, Sargis Robert M
College of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA.
School of Public Health, University of Illinois at Chicago, Chicago, IL 60612, USA.
J Endocr Soc. 2023 May 15;7(6):bvad062. doi: 10.1210/jendso/bvad062. eCollection 2023 May 5.
Diabetes rates in the United States are staggering and climbing. Importantly, traditional risk factors fail to completely account for the magnitude of the diabetes epidemic. Environmental exposures, including urban and metropolitan transportation quality, are implicated as contributors to disease. Using data from the county-level Environmental Quality Index (EQI) developed for the United States, we analyzed associations between transportation and air quality environmental metrics with overall diabetes prevalence and control within urban/metropolitan counties in the United States from 2006 to 2012. Additionally, we examined effect modification by race/ethnicity through stratification based on the county-level proportion of minority residents. Last, we applied mixture methods to evaluate the effect of simultaneous poor transportation factors and worse air quality on the same outcomes. We found that increased county-level particulate matter air pollution and nitrogen dioxide along with reduced public transportation usage and lower walkability were all associated with increased diabetes prevalence. The minority proportion of the population influences some of these relationships as some of the effects of air pollution and the transportation-related environment are worse among counties with more minority residents. Furthermore, the transportation and air quality mixtures were found to be associated with increased diabetes prevalence and reduced diabetes control. These data further support the burgeoning evidence that poor environments amplify diabetes risk. Future cohort studies should explore the utility of environmental policies and urban planning as tools for improving metabolic health.
美国的糖尿病发病率惊人且呈上升趋势。重要的是，传统风险因素无法完全解释糖尿病流行的程度。包括城市和大都市交通质量在内的环境暴露被认为是导致疾病的因素。利用为美国开发的县级环境质量指数（EQI）数据，我们分析了2006年至2012年美国城市/大都市县内交通和空气质量环境指标与总体糖尿病患病率及控制情况之间的关联。此外，我们通过基于少数族裔居民县级比例的分层来研究种族/族裔的效应修正。最后，我们应用混合方法来评估交通因素差和空气质量差同时出现对相同结果的影响。我们发现，县级颗粒物空气污染和二氧化氮增加，以及公共交通使用率降低和步行便利性降低，都与糖尿病患病率增加有关。人口中的少数族裔比例影响其中一些关系，因为在少数族裔居民较多的县，空气污染和与交通相关环境的一些影响更严重。此外，发现交通和空气质量的综合影响与糖尿病患病率增加和糖尿病控制情况变差有关。这些数据进一步支持了越来越多的证据，即恶劣环境会增加糖尿病风险。未来的队列研究应探索环境政策和城市规划作为改善代谢健康工具的效用。
