Long-Term Exposure to Ambient PM2.5 and Incidence of Diabetes in China: A Cohort Study

摘要

Background: Fine particulate matter (PM2.5) exposure has been linked to increased risk of various diseases. However, associations between air pollution and the chronic development of diabetes were rarely reported, especially in China. In this work, a cohort-based study was conducted to assess the incidence of diabetes associated with long-term exposure to ambient PM2.5. Methods: We collected health data and risk factors from the project of Prediction for Atherosclerotic Cardiovascular Disease Risk in China (China-PAR Project), with a sample of 127,840 Chinese adults aged 35 to 74 years studied. To match our PM2.5 exposure data, follow-up information from 2004 to 2015 was analyzed. Individual levels of PM2.5 exposure were estimated from satellite-based PM2.5 concentrations at 10 km resolution. Time-weighted average level based on each subject's geocoded addresses during the study period was presented as the long-term exposure of PM2.5. Cox proportional hazards model was employed to estimate the incidence of diabetes attributable to long-term exposure of PM2.5, with age, gender, smoking status, education level, body mass index and long-term levels of temperature and relative humidity adjusted. Nested random intercept of study cohorts and clusters were fitted in the model. Results: With 553,303 person-years of follow-up after 2004, the incidence of diabetes was 11.5 and 11.6 per 1000 person-years in men and women, respectively. For an increase of 10 μg/m3 in long-term PM2.5 exposure, the adjusted percent increase in the incidence of diabetes was 15.05% (95% confidence interval: 6.10%, 24.75%). The increases were larger among the women, non-smokers and the subjects who were living in rural areas. Conclusions: Long-term exposure to ambient PM2.5 is a risk factor for diabetes in China. A sustained improvement of air pollution may benefit for the reduction of diabetes incidence in population.