Hu Mengxiao, Hao Xiaowei, Zhang Yunquan, Sun Xiaofeng, Zhang Meng, Zhao Jingyi, Wang Qing
Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.
National Institute of Health Data Science of China, Shandong University, Jinan, Shandong, 250012, China.
BMC Public Health. 2025 Apr 26;25(1):1565. doi: 10.1186/s12889-025-22394-z.
Recent Western studies link long-term particulate matter (PM) exposure to type 2 diabetes mellitus (T2DM) progression, but little is known for low- and middle-income countries. This study aimed to estimate the relationship between PM exposure and T2DM progression in China, and also assess urban-rural disparities.
Using 7-year cohort data of 1.3 million Chinese over 40, a multistate model estimated the associations of PM exposure with T2DM progression. Covariates included demographics, socioeconomic status, health behaviors, medication, and meteorological factors. Sub-sample analyses were done for rural and urban areas.
For participants exposed to high levels of , the 5-year absolute risks of developing T2DM and its complications were 4.31% (95% CI: 4.22-4.40) and 31.04% (95% CI: 29.97-32.08), respectively. In the low- -exposure group, these risks were 3.82% (95% CI: 3.74-3.91) and 30.55% (95% CI: 29.43-31.65). For each 10 µg/m increase in exposure, the HRs (95% CI) for the progression from no T2DM diagnosis to a T2DM diagnosis were 1.13 (1.13-1.14), and for the progression from T2DM to the development of T2DM complications were 1.04 (1.03-1.06). Moreover, the HRs (95% CI) for mortality risk were 1.09 (1.08-1.09) for participants without T2DM, 1.06 (1.00-1.14) for those with T2DM, and 1.10 (1.05-1.16) for those with T2DM complications. Similar associations were observed for other PM-related metrics. In rural areas, PM exposure was more strongly associated with the progression from T2DM and its complications to death. Conversely, in urban areas, PM exposure had a stronger association with the progression from a non-T2DM state to a formal T2DM diagnosis. Urban residents are exposed to higher levels of toxic components like heavy metals, potentially increasing T2DM risk, yet urban healthcare infrastructure offers protection against T2DM-related mortality.
PM exposure is significantly associated with T2DM progression. Urban areas should focus on primary prevention, while rural areas need to improve secondary and tertiary prevention like healthcare services.
西方近期的研究将长期接触颗粒物（PM）与2型糖尿病（T2DM）的进展联系起来，但对于低收入和中等收入国家知之甚少。本研究旨在评估中国PM暴露与T2DM进展之间的关系，并评估城乡差异。
利用130万40岁以上中国人的7年队列数据，采用多状态模型估计PM暴露与T2DM进展之间的关联。协变量包括人口统计学、社会经济地位、健康行为、用药情况和气象因素。对农村和城市地区进行了子样本分析。
对于暴露于高水平PM2.5的参与者，患T2DM及其并发症的5年绝对风险分别为4.31%（95%CI：4.22-4.40）和31.04%（95%CI：29.97-32.08）。在低PM2.5暴露组中，这些风险分别为3.82%（95%CI：3.74-3.91）和30.55%（95%CI：29.43-31.65）。PM2.5暴露每增加10μg/m³，从无T2DM诊断进展为T2DM诊断的HR（95%CI）为1.13（1.13-1.14），从T2DM进展为T2DM并发症的HR（95%CI）为1.04（1.03-1.06）。此外，无T2DM参与者的死亡风险HR（95%CI）为1.09（1.08-1.09），患有T2DM的参与者为1.06（1.00-1.14），患有T2DM并发症的参与者为1.10（1.05-1.16）。其他与PM相关的指标也观察到类似的关联。在农村地区，PM暴露与T2DM及其并发症进展至死亡之间的关联更强。相反，在城市地区，PM暴露与从非T2DM状态进展为正式T2DM诊断之间的关联更强。城市居民接触到更高水平的重金属等有毒成分，可能增加T2DM风险，但城市医疗基础设施提供了针对T2DM相关死亡率的保护。
PM暴露与T2DM进展显著相关。城市地区应注重一级预防，而农村地区需要改善二级和三级预防，如医疗服务。
