Li Chunnan, Qi Jinlei, Yin Peng, Yu Xinhui, Sun Haoran, Zhou Maigeng, Liang Wannian
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, 02115, Massachusetts, USA.
Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, 02115, Massachusetts, USA.
Lancet Reg Health West Pac. 2024 Nov 26;53:101246. doi: 10.1016/j.lanwpc.2024.101246. eCollection 2024 Dec.
Temporal trends and geographical disparities in type 2 diabetes burden attributable to air pollution, including ambient and household, are not fully understood within China. This study aims to estimate the burden of type 2 diabetes attributable to air pollution at national and provincial levels from 1990 to 2021.
We assessed air pollution exposure across 33 Chinese provinces, autonomous regions, municipalities, and special administrative regions, focusing on two common forms of air pollution: ambient particulate matter pollution (defined as the annual gridded concentration of PM) and household air pollution (defined as the percentage of households using solid cooking fuels and their corresponding exposure to PM). We employed the methods from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 to estimate the attribution of air pollution on type 2 diabetes deaths and disability-adjusted life years (DALYs) by age, sex, year, and province.
In 2021, about a fifth of the national type 2 diabetes burden was attributable to air pollution, with an age-standardised estimate of 1.76 deaths and 110.79 DALYs per 100,000 population, higher in males. Ambient PM contributed to 16.89% of deaths and 16.36% of DALYs, while household air pollution contributed to 3.24% of deaths and 3.07% of DALYs. From 1990 to 2021, type 2 diabetes mortality rates due to ambient PM pollution increased by 264.23%, whereas those from household air pollution decreased by 80.8%. In 2021, Beijing had the highest population attributable fraction (PAFs) of DALYs due to ambient PM pollution at 19.63%, while Tibet had the highest PAFs for household air pollution at 13.72%. The age-standardised DALYs rates for type 2 diabetes due to ambient PM varied widely across provinces, from 143.8 per 100,000 people in Tianjin to 21.6 per 100,000 people in Tibet.
Air pollution, especially ambient PM, is a significant risk factor for type 2 diabetes in China. Urgent action is needed to enhance air pollution control and develop locally adapted preventive strategies to reduce the burden of air pollution-related type 2 diabetes.
Sanming Project of Medicine in Shenzhen (NO. SZSM202111001).
在中国，空气污染（包括室外和室内空气污染）所致2型糖尿病负担的时间趋势和地域差异尚未完全明晰。本研究旨在估算1990年至2021年期间全国及省级层面空气污染所致2型糖尿病的负担。
我们评估了中国33个省、自治区、直辖市和特别行政区的空气污染暴露情况，重点关注两种常见的空气污染形式：室外颗粒物污染（定义为PM的年度网格化浓度）和室内空气污染（定义为使用固体烹饪燃料的家庭百分比及其相应的PM暴露）。我们采用了《2021年全球疾病、伤害和风险因素负担研究》（GBD 2021）中的方法，按年龄、性别、年份和省份估算空气污染对2型糖尿病死亡和伤残调整生命年（DALYs）的归因。
2021年，全国约五分之一的2型糖尿病负担可归因于空气污染，年龄标准化估计为每10万人中有1.76例死亡和110.79个DALYs，男性的该数值更高。室外PM导致了16.89%的死亡和16.36%的DALYs，而室内空气污染导致了3.24%的死亡和3.07%的DALYs。1990年至2021年期间，室外PM污染导致的2型糖尿病死亡率上升了264.23%，而室内空气污染导致的死亡率下降了80.8%。2021年，北京因室外PM污染导致的DALYs人群归因分数（PAFs）最高，为19.63%，而西藏因室内空气污染导致的PAFs最高，为13.72%。各省份因室外PM导致的2型糖尿病年龄标准化DALYs率差异很大，从天津的每10万人143.8例到西藏的每10万人21.6例不等。
空气污染，尤其是室外PM，是中国2型糖尿病的重要风险因素。需要采取紧急行动加强空气污染控制，并制定因地制宜的预防策略，以减轻与空气污染相关的2型糖尿病负担。
深圳医疗卫生三名工程（编号：SZSM202111001）
