Long-term exposure to ambient fine particulate matter and incidence of diabetes in China: A cohort study

Secular trends in type 2 diabetes mellitus attributable to PM2.5 exposure in China from 1990 to 2019: an age-period-cohort analysis

Secular trends of mortality and disability-adjusted life years (DALY) in type 2 diabetes mellitus (T2DM) attributable to PM2.5 exposure in China remain unclear. This study applied the joinpoint regression analysis and age-period-cohort model to assess the secular trends. There was a slight alternation in age-standardized rate of mortality and DALY in the total population, while the changes were increased in males and decreased in females from 1990 to 2019. Meanwhile, the changes attributable to ambient particular matter pollution exposure (APE) increased significantly and reduced household air pollution from solid fuels exposure (HPE). Longitudinal age curves showed that T2DM mortality and DALY increased with age. Period rate ratios (RR) attributable to APE increased but fell to HPE. Similar trends were observed in the cohort RR. PM2.5 exposure is more harmful to males and older people. The type of air pollution responsible for T2DM has changed from HPE to APE.

Ambient air fine particulate matter (PM10 and PM2.5) and risk of type 2 diabetes mellitus and mechanisms of effects: a global systematic review and meta-analysis

Type 2 diabetes causes early mortality worldwide. Air pollution's relationship with T2DM has been studied. The association between them is unclear because of inconsistent outcomes. Studies on this topic have been published since 2019, but not thoroughly evaluated. We conducted a systematic review and meta-analysis using relevant data. The study protocol was registered in PROSPIRO and conducted according to MOOSE guidelines. In total, 4510 manuscripts were found. After screening, 46 studies were assessed using the OHAT tool. This meta-analysis evaluated fine particles with T2DM using OR and HR effect estimates. Evaluation of publication bias was conducted by Egger's test, Begg's test, and funnel plot analysis. A sensitivity analysis was conducted to evaluate the influence of several studies on the total estimations. Results show a significant association between PM2.5 and PM10 exposure and T2DM. Long-term exposure to fine air particles may increase the prevalence and incidence of T2DM. Fine air pollution increases the chance of developing T2DM mainly via systemic inflammation, oxidative stress, and endoplasmic reticulum stress.

Gut microbiota mediates ambient PM2.5 exposure-induced abnormal glucose metabolism via short-chain fatty acids

PM2.5 exposure has been found to cause gut dysbiosis and impair glucose homeostasis in human and animals, yet their underlying biological connection remain unclear. In the present study, we aim to investigate the biological significance of gut microbiota in PM2.5-induced glucose metabolic abnormalities. Our results showed that microbiota depletion by antibiotics treatment significantly alleviated PM2.5-induced glucose intolerance and insulin resistance, as indicated by the intraperitoneal glucose tolerance test, glucose-induced insulin secretion, insulin tolerance test, insulin-induced phosphorylation levels of Akt and GSK-3β in insulin sensitive tissues. In addition, faecal microbiota transplantation (FMT) from PM2.5-exposed donor mice successfully remodeled the glucose metabolism abnormalities in recipient mice, while the transplantation of autoclaved faecal materials did not. Faecal microbiota analysis demonstrated that the composition and alpha diversity of the gut bacterial community were altered by PM2.5 exposure and in FMT recipient mice. Furthermore, short-chain fatty acids levels analysis showed that the circulating acetate was significantly decreased in PM2.5-exposed donor and FMT recipient mice, and supplementation of sodium acetate for 3 months successfully improved the glucose metabolism abnormalities induced by PM2.5 exposure. These results indicate that manipulating gut microbiota or its metabolites could be a potential strategy for preventing the adverse health effects of ambient PM2.5.

The effects of fine particulate matter, solid fuel use and greenness on the risks of diabetes in middle-aged and older Chinese

BACKGROUND

Previous studies provided clues that environmental factors were closely related to diabetes incidence. However, the evidence from high-quality and large cohort studies about the effects of PM2.5, solid fuel use and greenness on the development of diabetes among middle-aged and older adults in China was scarce.

OBJECTIVE

To separately investigate the independent effects of PM2.5, solid fuel use and greenness on the development of diabetes among middle-aged and older adults.

METHODS

A total of 9242 participants were involved in this study extracted from the China Health and Retirement Longitudinal Study. Time-varying Cox regression was applied to detect the association of diabetes with PM2.5, solid fuel use and greenness, separately. The potential interactive effect of air pollution and greenness were explored using the relative excess risk due to interaction (RERI).

RESULTS

Per 10 μg/m3 increases in PM2.5 were associated with 6.0% (95% CI: 1.9, 10.2) increasing risks of diabetes incidence. Females seemed to be more susceptible to PM2.5. However, the effects of solid fuel use only existed in older and lower BMI populations, with hazard ratios (HRs) of 1.404 (1.116, 1.766) and 1.346 (1.057, 1.715), respectively. In addition, exposure to high-level greenness might reduce the risks of developing diabetes [HR = 0.801 (0.687, 0.934)]. Weak evidence of the interaction effect of PM2.5/solid fuel use and greenness on diabetes was found.

SIGNIFICANCE

Both PM2.5 and solid fuel use were associated with the increasing incidence of diabetes. In addition, high-level greenness might be a beneficial environmental factor for reducing the risks of developing diabetes. All in all, our findings might provide valuable references for public health apartments to formulate very fruitful policies to reduce the burden of diabetes.

IMPACT STATEMENT

Both PM2.5 and solid fuel use were associated with the increasing incidence of diabetes while high-level greenness was not, which might provide valuable references for public health apartments to make policies.

Type 2 diabetes attributable to ambient particulate matter pollution: a global burden study from 1990 to 2019

Background

This study assesses the changes over time and geographical locations in the disease burden of type 2 diabetes (T2D) attributed to ambient particulate matter pollution (APMP) from 1990 to 2019 in 204 countries and regions with different socio-demographic indexes (SDI).

Methods

The Global Burden of Diseases Study 2019 (GBD2019) database was used to analyze the global burden of T2D attributed to APMP. This study evaluated both the age-standardized death rate (ASDR) and disability-adjusted life years (DALYs) related to T2D, comparing data from 1990 to 2019. Estimated Annual Percentage Changes (EAPCs) were also utilized to investigate the trends over the 30-year study period.

Results

The global age-standardized DALY rate and ASDR exhibited an increasing trend, with an EAPC of 2.21 (95% CI: 2.15 to 2.27) and 1.50 (95% CI: 1.43 to 1.58), respectively. This rise was most notable among older adult populations, men, regions in Africa and Asia, as well as low-middle SDI regions. In 2019, the ASDR for T2D caused by APMP was recorded at 2.47 per 100,000 population, while the DALY rate stood at 108.98 per 100,000 population. Males and countries with middle SDI levels displayed significantly high age-standardized death and DALY rates, particularly noticeable in Southern Sub-Saharan Africa. Conversely, regions with high SDI levels like High-income North America demonstrated decreasing trends.

Conclusion

This study reveals a significant increase in T2D worldwide as a result of APMP from 1990 to 2019, with a particular emphasis on its impact on men, the older adult, and regions with low to middle SDI levels. These results underscore the urgent necessity for implementing policies aimed at addressing air pollution in order to reduce the prevalence of T2D, especially in the areas most heavily affected.

Exercise ameliorates fine particulate matter-induced metabolic damage through the SIRT1/AMPKα/PGC1-α/NRF1 signaling pathway

Air pollution, particularly fine particulate matter (PM2.5), poses a major threat to human health. Exercise has long been recognized as a beneficial way to maintain physical health. However, there is limited research on whether exercise can mitigate the damage caused by PM2.5 exposure. In this study, the mice were exercised on the IITC treadmill for 1 h per day, then exposed to concentrated PM2.5 for 8 h. After 2, 4 and 6-month exercise and PM2.5 exposure, the glucose tolerance and insulin tolerance were determined. Meanwhile, the corresponding indicators in epididymal white adipose tissue (eWAT), brown adipose tissue (BAT) and skeletal muscle were detected. The results indicated that PM2.5 exposure significantly increased insulin resistance (IR), while exercise effectively attenuated this response. The observations of muscle, BAT and eWAT by transmission electron microscopy (TEM) showed that PM2.5 significantly reduced the number of mitochondria in all of the three tissues mentioned above, and decreased the mitochondrial area in skeletal muscle and BAT. Exercise reversed the changes in mitochondrial area in all of the three tissues, but had no effect on the reduction of mitochondrial number in skeletal muscle. At 2 months, the expressions of Mfn2, Mfn1, OPA1, Drp1 and Fis1 in eWAT of the PM mice showed no significant changes when compared with the corresponding FA mice. However, at 4 months and 6 months, the expression levels of these genes in PM mice were higher than those in the FA mice in skeletal muscle. Exercise intervention significantly reduced the upregulation of these genes induced by PM exposure. The study indicated that PM2.5 may impact mitochondrial biogenesis and dynamics by inhibiting the SIRT1/AMPKα/PGC1-α/NRF1 pathway, which further lead to IR, glucose and lipid disorders. However, exercise might alleviate the damages caused by PM2.5 exposure.

Long-term PM2.5 exposure and early-onset diabetes: Does BMI link this risk?

OBJECTIVE

Limited studies investigated the association between high-level fine particulate matter (PM2.5) pollution and early-onset diabetes, leaving the possible metabolic mechanisms unclear. We assessed the association of cumulative PM2.5 exposure with diabetes, including early-onset, in high-pollution areas of China and explored whether metabolic factors mediated this association.

METHODS

124,204 participants (≥18 years) from 121 counties in Hunan province, China, were enrolled between 2005 and 2020, with follow-up until 2021. The ground-level air pollution concentrations at each participant's residence were calculated using a high-quality dataset in China. The independent association of PM2.5 with incident diabetes and early-onset diabetes was assessed by Cox proportional hazards models. Restricted cubic splines were utilized to establish the exposure-response relationships. The role of metabolism-related mediators was estimated by mediation analysis.

RESULTS

During a median follow-up of 8.47 (IQR, 6.65-9.82) years, there were 3650 patients with new-onset diabetes. Each 1 μg/m3 increase in the level of cumulative PM2.5 exposure was positively related to an increased incidence of diabetes (HR 1.177, 95 % CI 1.172-1.181) among individuals in the PM2.5 > 50 μg/m3 group after adjusting for multiple variables. The relationship of the PM2.5 dose-response curve for diabetes was non-linear. Significant associations between PM2.5 exposure and early-onset diabetes risk were observed, with this risk showing an increase with the earlier age of early diabetes onset. Males, young individuals (≤45 years), and those with a lower body mass index (BMI <24 kg/m2) appeared to be more susceptible to diabetes. Moreover, change in BMI significantly mediated 31.06 % of the PM2.5-diabetes relationship.

CONCLUSIONS

Long-term cumulative PM2.5 exposure increased the risk of early-onset diabetes, which is partially mediated by BMI. Sustained air pollution control measures, priority protection of vulnerable individuals, and effective management of BMI should be taken to reduce the burden of diabetes.

Exposure to PM2.5 and its five constituents is associated with the incidence of type 2 diabetes mellitus: a prospective cohort study in northwest China

Studies have demonstrated that fine particulate matter (PM2.5) is an underlying risk factor for type 2 diabetes mellitus (T2DM), but evidence exploring the relationship between PM2.5 chemical components and T2DM was extremely limited, to investigate the effects of long-term exposure to PM2.5 and its five constituents (sulfate [SO42-], nitrate [NO3-], ammonium [NH4+]), organic matter [OM] and black carbon [BC]) on incidence of T2DM. Based on the "Jinchang Cohort" platform, a total of 19,884 participants were selected for analysis. Daily average concentrations of pollutants were gained from Tracking Air Pollution in China (TAP). Cox proportional hazards regression models were utilized to estimate the hazard ratios (HR) and 95% confidence interval (CI) in single-pollutant models, restricted cubic splines functions were used to examine the dose-response relationships, and quantile g-computation (QgC) was applied to evaluate the combined effect of PM2.5 compositions on T2DM. Stratification analysis was also considered. A total of 791 developed new cases of T2DM were observed during a follow-up period of 45254.16 person-years. The concentrations of PM2.5, NO3-, NH4+, OM and BC were significantly associated with incidence of T2DM (P-trend < 0.05), with the HRs in the highest quartiles of 2.16 (95% CI 1.79, 2.62), 1.43 (95% CI 1.16, 1.75), 1.75 (95% CI 1.45, 2.11), 1.31 (95% CI 1.08, 1.59) and 1.79 (95% CI 1.46, 2.21), respectively. Findings of QgC model showed a noticeably positive joint effect of one quartile increase in PM2.5 constituents on increased T2DM morbidity (HR 1.27, 95% CI 1.09, 1.49), and BC (32.7%) contributed the most to the overall effect. The drinkers, workers and subjects with hypertension, obesity, higher physical activity, and lower education and income were generally more susceptible to PM2.5 components hazards. Long-term exposure to PM2.5 and its components (i.e., NO3-, NH4+, OM, BC) was positively correlated with T2DM incidence. Moreover, BC may be the most responsible for the association between PM2.5 constituents and T2DM. In the future, more epidemiological and experimental studies are needed to identify the link and potential biological mechanisms.

Associations between PM2.5 and O3 exposures and new onset type 2 diabetes in regional and national samples in the United States

BACKGROUND

Exposure to particulate matter ≤2.5 μm in diameter (PM2.5) and ozone (O3) has been linked to numerous harmful health outcomes. While epidemiologic evidence has suggested a positive association with type 2 diabetes (T2D), there is heterogeneity in findings. We evaluated exposures to PM2.5 and O3 across three large samples in the US using a harmonized approach for exposure assignment and covariate adjustment.

METHODS

Data were obtained from the Veterans Administration Diabetes Risk (VADR) cohort (electronic health records [EHRs]), the Reasons for Geographic and Racial Disparities in Stroke (REGARDS) cohort (primary data collection), and the Geisinger health system (EHRs), and reflect the years 2003-2016 (REGARDS) and 2008-2016 (VADR and Geisinger). New onset T2D was ascertained using EHR information on medication orders, laboratory results, and T2D diagnoses (VADR and Geisinger) or report of T2D medication or diagnosis and/or elevated blood glucose levels (REGARDS). Exposure was assigned using pollutant annual averages from the Downscaler model. Models stratified by community type (higher density urban, lower density urban, suburban/small town, or rural census tracts) evaluated likelihood of new onset T2D in each study sample in single- and two-pollutant models of PM2.5 and O3.

RESULTS

In two pollutant models, associations of PM2.5, and new onset T2D were null in the REGARDS cohort except for in suburban/small town community types in models that also adjusted for NSEE, with an odds ratio (95% CI) of 1.51 (1.01, 2.25) per 5 μg/m3 of PM2.5. Results in the Geisinger sample were null. VADR sample results evidenced nonlinear associations for both pollutants; the shape of the association was dependent on community type.

CONCLUSIONS

Associations between PM2.5, O3 and new onset T2D differed across three large study samples in the US. None of the results from any of the three study populations found strong and clear positive associations.

Subchronic exposure to 1,2-naphthoquinone induces adipose tissue inflammation and changes the energy homeostasis of mice, partially due to TNFR1 and TLR4

Air pollution affects energy homeostasis detrimentally. Yet, knowledge of how each isolated pollutant can impact energy metabolism remains incomplete. The present study was designed to investigate the distinct effects of 1,2-naphthoquinone (1,2-NQ) on energy metabolism since this pollutant increases at the same rate as diesel combustion. In particular, we aimed to determine in vivo effects of subchronic exposure to 1,2-NQ on metabolic and inflammatory parameters of wild-type mice (WT) and to explore the involvement of tumor necrosis factor receptor 1 (TNFR1) and toll-like receptor 4 (TLR4) in this process. Males WT, TNFR1KO, and TLR4KO mice at eight weeks of age received 1,2-NQ or vehicle via nebulization five days a week for 17 weeks. In WT mice, 1,2-NQ slightly decreased the body mass compared to vehicle-WT. This effect was likely due to a mild food intake reduction and increased energy expenditure (EE) observed after six weeks of exposure. After nine weeks of exposure, we observed higher fasting blood glucose and impaired glucose tolerance, whereas insulin sensitivity was slightly improved compared to vehicle-WT. After 17 weeks of 1,2-NQ exposure, WT mice displayed an increased percentage of M1 and a decreased (p = 0.057) percentage of M2 macrophages in adipose tissue. The deletion of TNFR1 and TLR4 abolished most of the metabolic impacts caused by 1,2-NQ exposure, except for the EE and insulin sensitivity, which remained high in these mice under 1,2-NQ exposure. Our study demonstrates for the first time that subchronic exposure to 1,2-NQ affects energy metabolism in vivo. Although 1,2-NQ increased EE and slightly reduced feeding and body mass, the WT mice displayed higher inflammation in adipose tissue and impaired fasting blood glucose and glucose tolerance. Thus, in vivo subchronic exposure to 1,2-NQ is harmful, and TNFR1 and TLR4 are partially involved in these outcomes.

PM2.5 exposure, glycemic markers and incidence of type 2 diabetes in two large Indian cities

INTRODUCTION

Exposure to fine particulate matter has been associated with several cardiovascular and cardiometabolic diseases. However, such evidence mostly originates from low-pollution settings or cross-sectional studies, thus necessitating evidence from regions with high air pollution levels, such as India, where the burden of non-communicable diseases is high.

RESEARCH DESIGN AND METHODS

We studied the associations between ambient PM2.5 levels and fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c) and incident type 2 diabetes mellitus (T2DM) among 12 064 participants in an adult cohort from urban Chennai and Delhi, India. A meta-analytic approach was used to combine estimates, obtained from mixed-effects models and proportional hazards models, from the two cities.

RESULTS

We observed that 10 μg/m3 differences in monthly average exposure to PM2.5 was associated with a 0.40 mg/dL increase in FPG (95% CI 0.22 to 0.58) and 0.021 unit increase in HbA1c (95% CI 0.009 to 0.032). Further, 10 μg/m3 differences in annual average PM2.5 was associated with 1.22 (95% CI 1.09 to 1.36) times increased risk of incident T2DM, with non-linear exposure response.

CONCLUSIONS

We observed evidence of temporal association between PM2.5 exposure, and higher FPG and incident T2DM in two urban environments in India, thus highlighting the potential for population-based mitigation policies to reduce the growing burden of diabetes.

Reactive Oxygen Species-Triggered Curcumin Release from Hollow Mesoporous Silica Nanoparticles for PM2.5-Induced Acute Lung Injury Treatment

Exposure to fine particulate matter with a diameter ≤2.5 μm (PM_2.5) can result in serious inflammation and oxidative stress in lung tissue. However, there is presently very few effective treatments for PM_2.5-induced many pulmonary diseases, such as acute lung injury (ALI). Herein, curcumin-loaded reactive oxygen species (ROS)-responsive hollow mesoporous silica nanoparticles (Cur@HMSN-BSA) are proposed for scavenging the intracellular ROS and suppressing inflammatory responses against PM_2.5-induced ALI. The prepared nanoparticles were coated with bovine serum albumin (BSA) via an ROS-sensitive thioketal (TK)-containing linker, in which the TK-containing linker would be cleaved by the excessive amounts of ROS in inflammatory sites to induce the detachment of BSA from the nanoparticles surface and thus triggering release of loaded curcumin. The Cur@HMSN-BSA nanoparticles could be used as ROS scavengers because of their excellent ROS-responsiveness, which were able to efficiently consume high concentrations of intracellular ROS. Furthermore, it was also found that Cur@HMSN-BSA downregulated the secretion of several important pro-inflammatory cytokines and promoted the polarization from M1 phenotypic macrophages to M2 phenotypic macrophages for eliminating PM_2.5-induced inflammatory activation. Therefore, this work provided a promising strategy to synergistically scavenge intracellular ROS and suppress the inflammation responses, which may serve as an ideal therapeutic platform for pneumonia treatment.

Associations of the built environment with type 2 diabetes in Asia: a systematic review

OBJECTIVES

Our study aimed to systematically review the literature and synthesise findings on potential associations of built environment characteristics with type 2 diabetes (T2D) in Asia.

DESIGN

Systematic review of the literature.

DATA SOURCES

Online databases Medline, Embase and Global Health were used to identify peer-reviewed journal articles published from inception to 23 January 2023.

ELIGIBILITY CRITERIA

Eligible studies included cohort, cross-sectional and case-control studies that explored associations of built environment characteristics with T2D among adults 18 years and older in Asia.

DATA EXTRACTION AND SYNTHESIS

Covidence online was used to remove duplicates and perform title, abstract and full-text screening. Data extraction was carried out by two independent reviewers using the OVID database and data were imported into MS Excel. Out of 5208 identified studies, 28 studies were included in this systematic review. Due to heterogeneity in study design, built environment and outcome definitions, a semiqualitative analysis was conducted, which synthesised results using weighted z-scores.

RESULTS

Five broad categories of built environment characteristics were associated with T2D in Asia. These included urban green space, walkability, food environment, availability and accessibility of services such as recreational and healthcare facilities and air pollution. We found very strong evidence of a positive association of particulate matter (PM_2.5, PM₁₀), nitrogen dioxide and sulfur dioxide (p<0.001) with T2D risk.

CONCLUSION

Several built environment attributes were significantly related to T2D in Asia. When compared with Western countries, very few studies have been conducted in Asia. Further research is, therefore, warranted to establish the importance of the built environment on T2D. Such evidence is essential for public health and planning policies to (re)design neighbourhoods and help improve public health across Asian countries.

PROSPERO REGISTRATION NUMBER

CRD42020214852.

Ambient fine particulate matter and cardiopulmonary health risks in China

ABSTRACT

In China, the level of ambient fine particulate matter (PM 2.5 ) pollution far exceeds the air quality standards recommended by the World Health Organization. Moreover, the health effects of PM 2.5 exposure have become a major public health issue. More than half of PM 2.5 -related excess deaths are caused by cardiopulmonary disease, which has become a major health risk associated with PM 2.5 pollution. In this review, we discussed the latest epidemiological advances relating to the health effects of PM 2.5 on cardiopulmonary diseases in China, including studies relating to the effects of PM 2.5 on mortality, morbidity, and risk factors for cardiovascular and respiratory diseases. These data provided important evidence to highlight the cardiopulmonary risk associated with PM 2.5 across the world. In the future, further studies need to be carried out to investigate the specific relationship between the constituents and sources of PM 2.5 and cardiopulmonary disease. These studies provided scientific evidence for precise reduction measurement of pollution sources and public health risks. It is also necessary to identify effective biomarkers and elucidate the biological mechanisms and pathways involved; this may help us to take steps to reduce PM 2.5 pollution and reduce the incidence of cardiopulmonary disease.

Associations between Household Solid Fuel Use, Obesity, and Cardiometabolic Health in China: A Cohort Study from 2011 to 2018

This study aims to explore the longitudinal relationship between solid fuel use and CMD incidence based on a nationally representative follow-up cohort study. A total of 6038 participants of the China Health and Retirement Longitudinal Study (CHARLS) were enrolled in the study. CMD is a cluster of diseases that include heart disease, stroke, and type 2 diabetes. Cox proportional-hazards regression models were used to examine the association between solid fuel use and the incidence or multimorbidity of CMD. The interactions between overweight or obesity and household air pollution on CMD incidence were also investigated. In the present study, solid fuel use from cooking or heating, separately or simultaneously, was positively associated with CMD incidence. Elevated solid fuel use was significantly associated with a higher risk of CMD incidence (HR = 1.25, 95% CI: 1.09, 1.43 for cooking; HR = 1.27, 95% CI: 1.11, 1.45 for heating). A statistically significant interaction between household solid fuel and OW/OB on the incidence of CMD and Cardiometabolic multimorbidity was also observed (p < 0.05). Our findings show that household solid fuel is a risk factor for the incidence of CMD. Therefore, reducing household solid fuel use and promoting clean energy may have great public health value for the prevention of CMD.

Projected rapid growth in diabetes disease burden and economic burden in China: a spatio-temporal study from 2020 to 2030

Background

This study projects the trend of disease burden and economic burden of diabetes in 33 Chinese provinces and nationally during 2020-2030 and investigates its spatial disparities.

Methods

Time series prediction on the prevalence and disability-adjusted life-year (DALY) rates of diabetes was conducted using a Bayesian modelling approach in 2020-2030. The top-down method and the human capital method were used to predict the direct and indirect costs of diabetes for each Chinese province. Global and local spatial autocorrelation analyses were used to identify geographic clusters of low-or high-burden areas.

Findings

Diabetes prevalence in Chinese adults aged 20-79 years was projected to increase from 8.2% to 9.7% during 2020-2030. During the same period, the total costs of diabetes would increase from $250.2 billion to $460.4 billion, corresponding to an annual growth rate of 6.32%. The total costs of diabetes as a percentage of GDP would increase from 1.58% to 1.69% in China during 2020-2030, suggesting a faster growth in the economic burden of diabetes than China's economic growth. Consistently, the per-capita economic burden of diabetes would increase from $231 to $414 in China during 2020-2030, with an annual growth rate of 6.02%. High disease and economic burden areas were aggregated in Northeast and/or North China.

Interpretation

Our study projects a significant growth of disease and economic burden of diabetes in China during 2020-2030, with strong spatial aggregation in northern Chinese regions. The increase in the economic burden of diabetes will exceed that of GDP.

Funding

National Natural Science Foundation of China, Outstanding Young Scholars Funding.

Long-term residential exposure to source-specific particulate matter and incidence of diabetes mellitus - A cohort study in northern Sweden

Diabetes mellitus (DM) incidence have been assessed in connection with air pollution exposure in several studies; however, few have investigated associations with source-specific local emissions. This study aims to estimate the risk of DM incidence associated with source-specific air pollution in a Swedish cohort with relatively low exposure. Individuals in the Västerbotten intervention programme cohort were followed until either a DM diagnosis or initiation of treatment with glucose-lowering medication occurred. Dispersion models with high spatial resolution were used to estimate annual mean concentrations of particulate matter (PM) with aerodynamic diameter ≤10 μm (PM₁₀) and ≤2.5 μm (PM_2.5) at individual addresses. Hazard ratios were estimated using Cox regression models in relation to moving averages 1-5 years preceding the outcome. During the study period, 1479 incident cases of DM were observed during 261,703 person-years of follow-up. Increased incidence of DM was observed in association with PM₁₀ (4% [95% CI: -54-137%] per 10 μg/m³), PM₁₀-traffic (2% [95% CI: -6-11%] per 1 μg/m³) and PM_2.5-exhaust (11% [95% CI: -39-103%] per 1 μg/m³). A negative association was found for both PM_2.5 (-18% [95% CI: -99-66%] per 5 μg/m³), but only in the 2nd exposure tertile (-10% [95% CI: -25-9%] compared to the first tertile), and PM_2.5-woodburning (-30% [95% CI: -49-4%] per 1 μg/m³). In two-pollutant models including PM_2.5-woodburning, there was an 11% [95% CI: -11-38%], 6% [95% CI: -16-34%], 13% [95% CI: -7-36%] and 17% [95% CI: 4-41%] higher risk in the 3rd tertile of PM₁₀, PM_2.5, PM₁₀-traffic and PM_2.5-exhaust, respectively, compared to the 1st. Although the results lacked in precision they are generally in line with the current evidence detailing particulate matter air pollution from traffic as an environmental risk factor for DM.

Effect of long-term exposure to PM2.5 on the risk of type 2 diabetes and arthritis in type 2 diabetes patients: Evidence from a national cohort in China

BACKGROUND

It remains unclear whether type 2 diabetes and the complication of arthritis are causally related to the PM_2.5 pollutant. Therefore, we aimed to investigate the associations of long-term PM_2.5 exposure with type 2 diabetes and with arthritis in type 2 diabetes patients.

MATERIALS AND METHODS

This study used data from the China Health and Retirement Longitudinal Survey (CHARLS) implemented during 2011-2018. The associations were analyzed by Cox proportional hazards regression models, and the population-attributable fraction (PAF) was calculated to assess the burden of type 2 diabetes and arthritis-attributable to PM_2.5.

RESULTS

A total of 21,075 participants were finally included, with 19,121 analyzed for PM_2.5 and type 2 diabetes risk and 12,427 analyzed for PM_2.5 and arthritis risk, of which 1,382 with newly-diagnosed type 2 diabetes and 1,328 with arthritis during the follow-up. Overall, each 10 μg/m³ increment in PM_2.5 concentration was significantly associated with an increase in the risk of type 2 diabetes (HR = 1.26, 95 %CI1.22 to 1.31), and the PAF of type 2 diabetes attributable to PM_2.5 was 13.54 %. In type 2 diabetes patients, each 10 μg/m³ increment in PM_2.5 exposure was associated with an increase in arthritis (HR = 1.42, 95 %CI: 1.28 to 1.57), and the association was significantly greater than that (H = 1.23, 95 %CI: 1.19 to 1.28) in adults without type 2 diabetes. The PAFs of arthritis-attributable to PM_2.5 in participants with and without type 2 diabetes were 18.54 % and 10.69 %, respectively.

CONCLUSION

Long-term exposure to PM_2.5 may increase the risk of type 2 diabetes and make type 2 diabetes patients susceptible to arthritis.

Association of long-term air pollution exposure with the risk of prediabetes and diabetes: Systematic perspective from inflammatory mechanisms, glucose homeostasis pathway to preventive strategies

BACKGROUND

Limited evidence suggests the association of air pollutants with a series of diabetic cascades including inflammatory pathways, glucose homeostasis disorder, and prediabetes and diabetes. Subclinical strategies for preventing such pollutants-induced effects remain unknown.

METHODS

We conducted a cross-sectional study in two typically air-polluted Chinese cities in 2018-2020. One-year average PM₁, PM_2.5, PM₁₀, SO₂, NO₂, and O₃ were calculated according to participants' residence. GAM multinomial logistic regression was performed to investigate the association of air pollutants with diabetes status. GAM and quantile g-computation were respectively performed to investigate individual and joint effects of air pollutants on glucose homeostasis markers (glucose, insulin, HbA1c, HOMA-IR, HOMA-B and HOMA-S). Complement C3 and hsCRP were analyzed as potential mediators. The ABCS criteria and hemoglobin glycation index (HGI) were examined for their potential in preventive strategy.

RESULTS

Long-term air pollutants exposure was associated with the risk of prediabetes [Prevalence ratio for O₃ (PR_O₃) = 1.96 (95% CI: 1.24, 3.03)] and diabetes [PR_PM₁ = 1.18 (95% CI: 1.05, 1.32); PR_PM_2.5 = 1.08 (95% CI: 1.00, 1.16); PR_O₃ = 1.35 (95% CI: 1.03, 1.74)]. PM₁, PM₁₀, SO₂ or O₃ exposure was associated with glucose-homeostasis disorder. For example, O₃ exposure was associated with increased levels of glucose [7.67% (95% CI: 1.75, 13.92)], insulin [19.98% (95% CI: 4.53, 37.72)], HOMA-IR [34.88% (95% CI: 13.81, 59.84)], and decreased levels of HOMA-S [-25.88% (95% CI: -37.46, -12.16)]. Complement C3 and hsCRP played mediating roles in these relationships with proportion mediated ranging from 6.95% to 60.64%. Participants with HGI ≤ -0.53 were protected from the adverse effects of air pollutants.

CONCLUSION

Our study provides comprehensive insights into air pollutant-associated diabetic cascade and suggests subclinical preventive strategies.

Sustained air pollution exposures, fasting plasma glucose, glycated haemoglobin, prevalence and incidence of diabetes: a nationwide study in China

BACKGROUND

Evidence remains limited and inconsistent for the associations between sustained air pollution exposures and diabetes development. This study aimed to determine the potential effects of particulate matter with a diameter of ≤10 micrometres (PM10), particulate matter with a diameter of ≤2.5 micrometres (PM2.5) and nitrogen dioxide (NO2) on alterations of fasting plasma glucose (FPG), glycated haemoglobin (HbA1c), in particular, on prevalence and incidence of diabetes.

METHODS

Cross-sectional analyses were conducted based on 9628 participants aged ≥45 years from the baseline survey (2011) of the China Health and Retirement Longitudinal Study (CHARLS), whereas cohort analyses were based on 3510 individuals without diabetes at baseline in the third survey (2015). Residences of participants were geocoded and the air pollution exposures were estimated using a satellite-based spatiotemporal model. Linear, logistic and modified Poisson regression models, adjusting for multiple confounders, were applied to assess the associations between air pollution and FPG, HbA1c, prevalence and incidence of diabetes, respectively.

RESULTS

Associations between PM10, PM2.5 and increased levels of FPG and HbA1c were identified. The levels of FPG and HbA1c increased by 0.025 mmol/L (95% CI: 0.007, 0.044) and 0.011 mmol/L (95% CI: 0.002, 0.019), respectively, for a 10-μg/m3 increase in PM10, and the levels of FPG and HbA1c increased by 0.061 mmol/L (95% CI: 0.028, 0.096) and 0.016 mmol/L (95% CI: 0.000, 0.031), respectively, for a 10-μg/m3 increase in PM2.5. There were also positive associations between diabetes prevalence and PM2.5 and PM10. In the cohort analyses, PM10, PM2.5 and NO2 were associated with a higher incidence of diabetes.

CONCLUSION

Air pollution was allied to diabetes development in elderly Chinese populations. Considering the impact of the dramatic increase in the incidence and prevalence of diabetes in China, interventions to improve air quality are urgently needed.

The impact of prolonged exposure to air pollution on the incidence of chronic non-communicable disease based on a cohort in Tianjin

Evidence on the associations of prolonged ambient pollutants exposure with chronic non-communicable diseases among middle-aged and elderly residents is still limited. This prospective cohort study intends to investigate the long-term effects of ambient pollution on hypertension and diabetes incidence among relatively older residents in China. Individual particulate matter exposure levels were estimated by satellite-based model. Individual gaseous pollutants exposure levels were estimated by Inverse Distance Weighted model. A Cox regression model was employed to assess the risks of hypertension and diabetes morbidity linked to air pollutants exposures. The cross-product term of ambient pollutants exposure and covariates was further added into the regression model to test whether covariates would modify these air pollution-morbidity associations. During the period from 2014 to 2018, a total of 97,982 subjects completed follow-up. 12,371 incidents of hypertension and 2034 of diabetes occurred. In the multi-covariates model, the hazard ratios (HR) and 95% confidence interval (CI) were 1.49 (1.45-1.52), 1.28 (1.26-1.30), 1.17 (1.15-1.18), 1.21 (1.17-1.25) and 1.33 (1.31-1.35) for hypertension morbidity per 10 μg/m³ increment in PM₁, PM_2.5, PM₁₀, NO₂ and SO₂, respectively. For diabetes onsets, the HR (95% CI) were 1.17 (1.11-1.23), 1.09 (1.04-1.13), 1.06 (1.02-1.09), 1.02 (0.95-1.10), and 1.24 (1.19-1.29), respectively. In addition, for hypertension analyses, the effect estimates were more pronounced in the participants with age <60 years old, BMI ≥24 kg/m², and frequent alcohol drinking. These findings provided the evidence on elevated risks of morbidity of hypertension and diabetes associated with prolonged ambient pollutants exposure at relatively high levels.

Overview of particulate air pollution and human health in China: Evidence, challenges, and opportunities

Ambient particulate matter (PM) pollution in China continues to be a major public health challenge. With the release of the new WHO air quality guidelines in 2021, there is an urgent need for China to contemplate a revision of air quality standards (AQS). In the recent decade, there has been an increase in epidemiological studies on PM in China. A comprehensive evaluation of such epidemiological evidence among the Chinese population is central for revision of the AQS in China and in other developing countries with similar air pollution problems. We thus conducted a systematic review on the epidemiological literature of PM published in the recent decade. In summary, we identified the following: (1) short-term and long-term PM exposure increase mortality and morbidity risk without a discernible threshold, suggesting the necessity for continuous improvement in air quality; (2) the magnitude of long-term associations with mortality observed in China are comparable with those in developed countries, whereas the magnitude of short-term associations are appreciably smaller; (3) governmental clean air policies and personalized mitigation measures are potentially effective in protecting public and individual health, but need to be validated using mortality or morbidity outcomes; (4) particles of smaller size range and those originating from fossil fuel combustion appear to show larger relative health risks; and (5) molecular epidemiological studies provide evidence for the biological plausibility and mechanisms underlying the hazardous effects of PM. This updated review may serve as an epidemiological basis for China’s AQS revision and proposes several perspectives in designing future health studies.

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Acute effects of PM are smaller in China compared with developed countries

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Health effects caused by PM depend on particle composition, source, and size

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There are no thresholds for the health effects of PM

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Mechanistic studies support the biological plausibility of PM’s health effects

The air quality of Palangka Raya, Central Kalimantan, Indonesia: The impacts of forest fires on visibility

Airborne particles in urban Palangka Raya, Kalimantan from Oct 2011 until Oct 2020 have been collected and analyzed for PM_2.5, PM₁₀, and Black Carbon (BC) concentrations. Palangka Raya is a city that serves the capital of the Central Kalimantan province on the island of Borneo. Kalimantan is affected by peat fires that occur periodically. There were identified increases in PM_2.5 and PM₁₀ concentrations during El Niño periods. During the forest fire episode in September - October 2015, PM_2.5 and PM₁₀ concentrations increased significantly, to nearly 400 µg/m³ and 800 µg/m³, respectively, and visibility in the city was reduced to < 0.2 miles. The highest BC concentrations were observed during this massive forest fires episode. The regression analyses for PM_2.5, PM₁₀ and visibility in Palangka Raya during the period of 2011-2020, showed a non-linear correlation with reduction in visibility due to increased PM_2.5 and PM₁₀. There was no correlation for BC with visibility. Air quality in Palangka Raya was at a relatively good level with concentrations below the national ambient air quality standard when there were no forest fires event. Emissions from forest fires caused a substantial reduction in air quality reaching concentrations well above ambient air quality standards and are likely to have caused adverse health effects on the people living in the area.Implications: Indonesia has repeatedly experienced forest fires, especially on Kalimantan and Sumatera Islands, which burned large areas of peatland. The forest fires leading to increasing PM concentrations especially in the PM_2.5 size range which influence visibility. The seasonal variations of BC in Palangka Raya and the relationships of fine particulates with visibility were assessed. The results of regression analyses for PM_2.5 and PM₁₀ to visibility during the period of 2011-2020 showed non-linear relationships. An increasing of PM_2.5 and PM₁₀ concentrations during El Nino periods were detected well above the ambient air quality standard. To ensure effective and continued handling and prevention of forest and peatland fires, the government set up a special task force and review on several rules, including laws and government regulations as well as governor regulations that permit the burning of forest and peatland areas. These results are expected to be used to formulate more effective mitigations in reducing forest fires events in Indonesia.

Long-term exposure to PM2.5 constituents in relation to glucose levels and diabetes in middle-aged and older Chinese

BACKGROUND

Previous studies have indicated the associations between fine particulate matter (PM_2.5) exposure and diabetes or glucose levels. However, evidence linking PM_2.5 constituents and diabetes or glucose levels was extensively scarce, particularly in developing countries. This study aimed to investigate the associations of exposure to PM_2.5 and its five constituents (black carbon [BC], organic matter [OM], nitrate [NO₃^-], sulfate [SO₄^2-], and ammonium [NH₄⁺]) with diabetes and glucose levels among the middle-aged and elderly Chinese populations.

METHODS

A national cross-sectional sample of participants aged 45+ years was enrolled from 28 provinces across China's mainland. Health examination and questionnaire survey for each respondent were performed during 2011-2012. Diabetes was determined by alternative definitions, and the main definition (MD) was self-report diabetes or antidiabetic medicine use or HbA_1c ≥6.5 or fasting glucose ≥7 mmol/L or random glucose ≥11.1 mmol/L. Monthly exposure to PM_2.5 mass and its five constituents (BC, OM, NO₃^-, SO₄^2-, and NH₄⁺) for each participant at residence were estimated using satellite-based spatiotemporal prediction models. Generalized linear models and linear mixed-effects models were used to assess the effects of exposure to PM_2.5 and its constituents on diabetes or glucose levels, respectively. Stratification analyses were done by sex and age.

RESULTS

We included a total of 17,326 adults over 45 years in this study. The 3-year mean (interquartile range [IQR]) concentrations of PM_2.5, BC, OM, NO₃^-, SO₄^2-, and NH₄⁺ were 47.9 (27.4) µg/m³, 2.9 (2.2) µg/m³, 9.2 (6.6) µg/m³, 10.2 (9.4) µg/m³, 11.0 (5.2) µg/m³, and 7.1 (4.4) µg/m³, respectively. Per IQR rise in exposure to PM_2.5 was significantly associated with an increase of 0.133 mmol/L (95% confidence interval, 0.048-0.219) in glucose concentrations. Similar positive associations were observed for BC (0.097 mmol/L [0.012-0.181]), OM (0.160 mmol/L [0.065-0.256]), NO₃^- (0.145 mmol/L [0.039-0.251]), SO₄^2- (0.111 mmol/L [0.026-0.196]), and NH₄⁺ (0.135 mmol/L [0.041-0.230]). Under different diabetes definitions, PM_2.5 mass and selected constituents with the exception of SO₄^2- were all associated with a higher risk of prevalent diabetes. In MD-based analysis, similar positive associations were observed for four constituents, with corresponding odds ratios of 1.180 (1.097-1.270) for PM_2.5, 1.154 (1.079-1.235) for BC, 1.170 (1.079-1.270) for OM, 1.200 (1.098-1.312) for NO₃^-, and 1.123 (1.037-1.215) for NH₄⁺. Stratified analyses showed a significantly higher risk of diabetes in males (1.225 [1.064-1.411]) than females (1.024 [0.923-1.136]) when exposed to PM_2.5. Participants under 65 years were generally more vulnerable to diabetes hazards related to PM_2.5 constituents exposure.

CONCLUSIONS

Exposures to PM_2.5 and its constituents (i.e., BC, OM, NO₃^-, and NH₄⁺) were positively associated with increased risks of prevalent diabetes and elevated glucose levels in middle-aged and older adults.

The potential osteoporosis due to exposure to particulate matter in ambient air: Mechanisms and preventive methods

Air pollution and health consequences associated with exposure to air pollutants, such as particulate matter, are of serious concerns in societies. Over the recent years, numerous studies have investigated the relation of many diseases with air pollutants. This review used a search strategy to provide the comprehensive information on the relationship between particle matters and osteoporosis. To this end, three search databases were used to find the articles focused on particle matters and osteoporosis. After the screening process, 13 articles related to the purpose of the study were selected and the relevant data were extracted. The results indicated that osteoporosis is significantly associated with PM₁₀. However, this association with PM_2.5 remains unclear. In addition, particle materials indirectly lead to the osteoporosis and bone fractures as a consequence of reduced UV-B, reduced adsorption of vitamin D. Furthermore, they can lead to other diseases by use of drugs with adverse effects on bone health, and creating conditions that may increase the risk of falling in the elderly. This review shows that although more accurate research is needed to determine the mechanism and risk of exposure to particulate matter in the air on bone health, the negative effects of this pollutant on bone mineral density (BMD) are evident.Implications: PM is usually classified by its size or aerodynamic diameter; PM10 denotes particles < 10 µm in diameter; PM2.5 particles are <2.5 µm in diameter. Many epidemiological studies have shown that short-term exposure to PM might reduce lung function. However, short-term effects might be reversible, and the main concern is attributed to long-term exposure. A major public health concern that may be affected by numerous metabolic and even environmental risk factors is osteoporosis. The purpose of this systematic review was to investigate the role of PM in the occurrence or exacerbation of osteoporosis in citizens.

Association of long-term exposure to PM2.5 in workplace with fasting plasma glucose among asymptomatic adults: A multicenter study in North China

BACKGROUND

The impacts of long-term high exposure to PM2.5 in workplace on glucose metabolism in asymptomatic working adults (AWAs) have rarely been explored.

OBJECTIVES

To assess the relationship between long-term exposure to workplace PM2.5 and glucose metabolism in asymptomatic general working adults in heavily polluted regions.

METHODS

We used the baseline data of the asymptomatic working participants from the Beijing-Tianjin-Hebei Medical Examination Cohort, which recruited adults undergoing medical examinations. A machine learning-based spatial-temporal model was used to estimate daily average PM2.5 concentrations in the participants' workplaces. We assessed the association of long-term PM2.5 concentrations (three years prior to the interview) and fasting plasma glucose (FPG) using generalized linear mixed-effects models (GLMM) with inclusion of potential confounders. Stratified analyses by sex, age, BMI and smoking status, and two pollutant models were further performed.

RESULTS

A total of 37,619 individuals were interviewed and 28,865 were included in the analyses. The mean FPG was 5.20 (0.96) mmol/L, and the estimated three-year average concentration of PM2.5 exposure was 69.51 (6.92) μg/m3. We detected a significant association of long-term exposure to workplace PM2.5 and FPG, a 10 µg/m3 increase in the long-term workplace PM2.5 exposure was associated with 0.075 (95%CI: 0.050-0.100) mmol/L elevated FPG and 25% (OR = 1.25, 95%CI: 1.05-1.50) elevated odds of abnormal fasting glucose metabolism with control of the potential confounding. The detected association between workplace PM2.5 and FPG metabolism remained significant in males, individuals aged > 44 years, overweight and/or obese people, both smokers and non-smokers, and when NO2, SO2, O3, and CO were included in the model.

CONCLUSIONS

Long-term exposure to workplace PM2.5 was associated with elevated FPG and/or odds of abnormal glucose metabolism among AWAs. Male, middle-aged, overweight and/or obese AWAs were more susceptible to workplace PM2.5 regardless of smoking status.

Evaluation of associations between estimates of particulate matter exposure and new onset type 2 diabetes in the REGARDS cohort

BACKGROUND

Studies of PM_2.5 and type 2 diabetes employ differing methods for exposure assignment, which could explain inconsistencies in this growing literature. We hypothesized associations between PM_2.5 and new onset type 2 diabetes would differ by PM_2.5 exposure data source, duration, and community type.

METHODS

We identified participants of the US-based REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort who were free of diabetes at baseline (2003-2007); were geocoded at their residence; and had follow-up diabetes information. We assigned PM_2.5 exposure estimates to participants for periods of 1 year prior to baseline using three data sources, and 2 years prior to baseline for two of these data sources. We evaluated adjusted odds of new onset diabetes per 5 µg/m³ increases in PM_2.5 using generalized estimating equations with a binomial distribution and logit link, stratified by community type.

RESULTS

Among 11,208 participants, 1,409 (12.6%) had diabetes at follow-up. We observed no associations between PM_2.5 and diabetes in higher and lower density urban communities, but within suburban/small town and rural communities, increases of 5 µg/m³ PM_2.5 for 2 years (Downscaler model) were associated with diabetes (OR [95% CI] = 1.65 [1.09, 2.51], 1.56 [1.03, 2.36], respectively). Associations were consistent in direction and magnitude for all three PM_2.5 sources evaluated.

SIGNIFICANCE

1- and 2-year durations of PM_2.5 exposure estimates were associated with higher odds of incident diabetes in suburban/small town and rural communities, regardless of exposure data source. Associations within urban communities might be obfuscated by place-based confounding.

Effects of physical activity intensity on adulthood obesity as a function of long-term exposure to ambient PM2.5: Observations from a Chinese nationwide representative sample

Long-term exposure to PM_2.5 has been associated with increased obesity risk, while physical activity (PA) is a suggested protective factor. This raises a dilemma whether the increased dose of PM_2.5 due to PA-intensified ventilation would offset the benefits of PA. Using a national representative sample, we aim to (1) ascertain inclusive findings of the association between PA and obesity, and (2) examine whether PM_2.5 exposure modifies the PA-obesity relationship. We recruited 91,121 Chinese adults from 31 provinces using a multi-stage stratified-clustering random sampling method. PM_2.5 was estimated using a validated machine learning method with a spatial resolution of 0.1° × 0.1°. PA intensity was calculated as metabolic equivalent (MET)-hour/week by summing all activities. Body weight, height, and waist circumference (WC) were measured after overnight fasting. Obesity-related traits included continuous outcomes (Body mass index [BMI], WC, and waist-to-height ratio (WHtR)) and binomial outcomes (general obesity, abdominal obesity, and WHtR obesity). Generalized linear regression models were used to estimate the interaction effects between PM_2.5 and PA on obesity, controlling for covariates. The results indicated that each IQR increase in PA was associated with 0.078 (95% CI: -0.096 to -0.061) kg/m², 0.342 (-0.389 to -0.294) cm, and 0.0022 (-0.0025 to -0.0019) decrease in BMI, WC, and WHtR, respectively. The joint association showed that benefits of PA on obesity were attenuated as PM_2.5 increased. Risk of abdominal obesity decreased 11.3% (OR = 0.887, 95% CI: 0.866, 0.908) per IQR increase in PA among the low-PM_2.5 (≤55.9 μg/m³) exposure group, but only 5.5% (OR = 0.945, 95% CI: 0.930, 0.960) among the high-PM_2.5 (>55.9 μg/m³) exposure group. We concluded the increase in PA intensity was significantly associated with lower risk of obesity in adults living across mainland China, where annual level of PM_2.5 were mostly exceeding the standard. Reducing PM_2.5 exposure would enhance the PA benefits as a risk reduction strategy.

Long-term exposure to ambient fine particulate matter (PM2.5) and associations with cardiopulmonary diseases and lung cancer in Taiwan: a nationwide longitudinal cohort study

BACKGROUND

Although a number of studies have reported on the health effects of fine particulate matter (PM2.5) exposure, particularly in North American and European countries as well as China, the evidence about intermediate to high levels of PM2.5 exposures is still limited. We aimed to investigate the associations between long-term exposure to PM2.5 and risk of cardiopulmonary disease incidence in Taiwan with intermediate levels of PM2.5 exposure.

METHODS

A cohort of Taiwanese adults, who participated in the 2001, 2005, 2009 and 2013 National Health Interview Surveys, was followed through 2016 to identify cardiopulmonary disease onset. Exposure to PM2.5 was estimated by incorporating a widespread monitoring network of air quality monitoring stations and microsensors. We used time-dependent Cox regression models to examine the associations between the PM2.5 exposures and health outcomes, adjusting for individual characteristics and ecological covariates. The natural cubic spline functions were used to explore the non-linear effects of the PM2.5 exposure.

RESULTS

A total of 62 694 adults from 353 towns were enrolled. Each 10-μg/m3 increase in 5-year average exposure to PM2.5 was associated with a 4.8% increased risk of incident ischaemic heart disease (95% CI: -3.3, 13.6), 3.9% increased risk of incident stroke (95% CI: -2.9, 11.1), 6.7% increased risk of incident diabetes (95% CI: 1.1, 12.7), 15.7% increased risk of incident lung cancer (95% CI: -0.9, 35.1) and 11.5% increased risk of incident chronic obstructive pulmonary disease (95% CI: -0.8, 25.2). The concentration-response curve showed that there was no statistical evidence of non-linearity for most of the disease outcomes except for ischaemic heart disease (P for non-linearity = 0.014).

CONCLUSIONS

Long-term exposure to intermediate levels of ambient PM2.5 was associated with cardiopulmonary health outcomes. Our study adds value to future application and national burden of disease estimation in evaluating the health co-benefits from ambient air pollution reduction policy in Asian countries.

Air pollution exposure and incidence of type 2 diabetes in women: A prospective analysis from the Mexican Teachers' Cohort

BACKGROUND

Air pollution is a risk factor for type 2 diabetes (T2D). However, scarse longitudinal studies have evaluated this association in low- and middle-income countries, where 80% of the worldwide cases of T2D occur.

OBJECTIVE

Our aim was to estimate the association between PM_2.5 and NO₂ exposure and incident T2D, in the Mexican Teachers' Cohort (MTC).

METHODS

We selected a subsample of female teachers from the MTC from Mexico City metropolitan area (MCMA), recruited in 2008 and with active follow-up every three years. We assigned the monthly time-weighted exposures (PM_2.5 and NO₂) using home and work addresses, until failure, censoring or death. We developed two high resolution (1 × 1-km) spatiotemporal predictive generalized additive models of PM_2.5 and NO₂. Incident diabetes was identified through self-report and two administrative databases of registered diabetes patients. We fitted time-varying Cox models to estimate hazard ratios of the relation between PM_2.5 and NO₂ and incident T2D, adjusting for confounding variables that were identified using a causal model.

RESULTS

A total of 13,669 teachers were followed-up for a maximum of 11.5 years, over which 996 incident T2D cases (88 cases per 100,000 person-months) occurred. Incident T2D increased by 72% (HR = 1.72 [1.47-2.01]) for each 10 μg/m³ increase of PM_2.5, and 52% for each 10 ppb of NO₂ (HR = 1.52 [1.37-1.68]).

DISCUSSION

Mid-term exposure to PM_2.5 and NO₂ was associated with a higher risk of T2D after adjusting for indoor wood smoke, socioeconomic status, and physical activity. These associations were attenuated in two-pollutant models but remained positive when evaluated long-term exposure. This is the first prospective study to evaluate T2D risk by exposure to both pollutants, PM_2.5 and NO₂ in a population from an upper middle-income country in the Americas.

Association of long-term exposure to PM2.5 with hypertension and diabetes among the middle-aged and elderly people in Chinese mainland: a spatial study

Background

Epidemiological evidence has shown an association between long-term exposure to fine particulate matter (PM_2.5) and hypertension and diabetes, but few studies have considered the spatial properties of the samples. This study aimed to investigate the long-term effect of PM_2.5 exposure on hypertension and diabetes among middle-aged and elderly people in China based on a spatial study.

Methods

We conducted a national cross-sectional study of the most recently launched wave 4 2018 data of the China Health and Retirement Longitudinal Study (CHARLS) to calculate the prevalence of hypertension and diabetes. The exposure data of annual average PM_2.5 concentrations were estimated combined with satellite observations, chemical transport modeling, and ground-based monitoring. A shared component model (SCM) was used to explore the association of PM_2.5 with hypertension and diabetes, in which these two diseases borrowed information on spatial variations from each other. Then, we evaluated the effect variations in PM_2.5 in different periods and smoking status on changes in outcomes.

Results

The prevalence of hypertension and diabetes was 44.27% and 18.44%, respectively, among 19,529 participants. The annual average PM_2.5 concentration in 31 provinces ranged from 4.4 μg/m³ to 51.3 μg/m³ with an average of 27.86 μg/m³ in 2018. Spatial auto-correlations of the prevalence of hypertension and diabetes and PM_2.5 concentrations were seen (Moran’s I = 0.336, p = 0.01; Moran’s I = 0.288, p = 0.03; Moran’s I = 0.490, p = 0.01). An interquartile range (IQR: 16.2 μg/m³) increase in PM_2.5 concentrations was significantly associated with a higher prevalence of hypertension and diabetes with odds ratios (ORs) of 1.070 [95% credible interval (95% CrI): 1.034, 1.108] and 1.149 (95% CrI: 1.100, 1.200), respectively. Notably, the effect of PM_2.5 on both hypertension and diabetes was relatively stronger among non-smokers than smokers.

Conclusion

Our nationwide study demonstrated that long-term exposure to PM_2.5 might increase the risk of hypertension and diabetes, and could provide guidance to public policymakers to prevent and control hypertension and diabetes according to the spatial distribution patterns of the above effects in China.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12984-6.

Health Effects of Long-Term Exposure to Ambient PM2.5 in Asia-Pacific: a Systematic Review of Cohort Studies

Abstract

Purpose of Review

Health effects of long-term exposure to ambient PM_2.5 vary with regions, and 75% of the deaths attributable to PM_2.5 were estimated in Asia-Pacific in 2017. This systematic review aims to summarize the existing evidence from cohort studies on health effects of long-term exposure to ambient PM_2.5 in Asia-Pacific.

Recent Findings

In Asia-Pacific, 60 cohort studies were conducted in Australia, Mainland China, Hong Kong, Taiwan, and South Korea. They consistently supported associations of long-term exposure to PM_2.5 with increased all-cause/non-accidental and cardiovascular mortality as well as with incidence of cardiovascular diseases, type 2 diabetes mellitus, kidney diseases, and chronic obstructive pulmonary disease. Evidence for other health effects was limited. Inequalities were identified in PM_2.5-health associations.

Summary

To optimize air pollution control and public health prevention, further studies need to assess the health effects of long-term PM_2.5 exposure in understudied regions, the health effects of long-term PM_2.5 exposure on mortality and risk of type 2 diabetes mellitus, renal diseases, dementia and lung cancer, and inequalities in PM_2.5-health associations. Study design, especially exposure assessment methods, should be improved.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40572-022-00344-w.

Greenness alleviates the effects of ambient particulate matter on the risks of high blood pressure in children and adolescents

Both ambient particulate matter (PM) and decrease of greenness have been suggested as risk factors for high blood pressure (HBP) in children and adolescents. But most evidence were from cross-sectional studies with limited data from prospective cohorts. In this cohort study, we included 588,004 children and adolescents aged 7 to 18 years without HBP from 2005 to 2018 in Beijing (240,081) and Zhongshan (347,923) city of China. The cumulative incidence of HBP was 32.04%, and incidence rate was 14.86 per 100 person-year. After adjustment for confounders, the ten-unit increase in PM₁, PM_2.5, and PM₁₀ exposure was significantly associated with 43%, 70%, and 43%- higher risks of HBP, respectively, but the 0.1-unit increase in NDVI exposure was significantly associated with a 25% lower risk of HBP. The HRs of PM₁ on the HBP risk were 1.486 and 1.150 in the low and the high-level of greenness, and they were 2.635 and 2.507 for PM_2.5, and for PM₁₀ 1.367 and 1.702 in the two groups. The attributable fraction (AFs) of PM₁, PM_2.5, and PM₁₀ on HBP incidents were 13.74%, 40.08%, and 15.47% in the low-level of greenness, which simultaneously was higher than those in the high-level of greenness (AF = 4.62%, 17.28%, and 9.96%). The exposure to higher ambient PM air pollution and lower greenness around schools were associated with a higher risk of HBP in children and adolescents, but higher greenness alleviated the adverse effects of ambient PM₁ and PM_2.5 on the HBP risks. Our findings highlighted a synergic strategy in preventing childhood HBP by decreasing air pollution reduction and improving greenness concurrently.

Quercetin improves the adipose inflammatory response and insulin signaling to reduce "real-world" particulate matter-induced insulin resistance

Numerous epidemiological data and experimental studies support a strong link between fine particulate matter (less than 2.5 mm in aerodynamic diameter, PM_2.5) exposure and the development of insulin resistance/type 2 diabetes mellitus (T2DM). Quercetin (Que), a flavonoid compound with anti-inflammatory effects, has been confirmed to improve glucose metabolic disorders in rodents and humans. In this study, we investigated the underlying mechanisms of particulate matter (PM)-induced glucose metabolic disorder and subsequently examined the protective effect and mechanism of quercetin supplementation. Male C57BL/6 mice in the control group and PM group were exposed to ambient filtered air (FA) or PM (6 h/day, 7 days/week) for 18 weeks. Mice in the Que group were exposed to PM for 18 weeks and administered Que (50 or 100 mg/kg bw). Glucose tolerance, insulin sensitivity, and systemic and visceral white adipose tissue (vWAT) inflammatory responses were measured. The expression of proteins involved in insulin signal transduction in vWAT was assessed. Chronic PM exposure caused systemic and vWAT inflammation characterized by an increase in serum IL-6 and TNF-α levels and increased vWAT macrophage filtration, triggering NLRP3 inflammasome activation, impairing the classic glucose metabolism signal in vWAT, and inducing whole-body insulin resistance. Moreover, Que administration significantly alleviated systemic and vWAT inflammation, abolished NLRP3 inflammasome activation, and improved signaling abnormalities characteristic of insulin resistance in vWAT and adipocytes. Based on these findings, chronic PM exposure activated the NLRP3 inflammasome and subsequently caused systemic and WAT inflammation and impaired insulin signaling in vWAT and adipocytes. Most importantly, Que administration inhibited NLRP3 inflammasome-mediated inflammation and insulin signaling in vWAT to improve these adverse effects.

Long-term ambient PM2.5 exposure associated with cardiovascular risk factors in Chinese less educated population

INTRODUCTION

Long-term exposure to ambient air pollution is related to major cardiovascular risk factors including diabetes, hypertension, hyperlipidemia and overweight, but with few studies in high-concentration nations like China so far. We aimed to investigate the association between long-term exposure to ambient fine particulate matter (particles with an aerodynamic diameter ≤ 2.5 μm, PM_2.5) and major cardiovascular risk factors in China.

METHODS

Adult participants with selected biochemical tests were recruited from the Chinese Physiological Constant and Health Condition (CPCHC) survey conducted from 2007 to 2011. Gridded PM_2.5 data used were derived from satellite-observed data with adjustment of ground-observed data. District-level PM_2.5 data were generated to estimate the association using multivariate logistic regression model and generalized additive model.

RESULTS

A total of 19,236 participants from the CPCHC survey were included with an average age of 42.8 ± 16.1 years, of which nearly half were male (47.0%). The annual average PM_2.5 exposure before the CPCHC survey was 33.4 (14.8-53.4) μg/m³, ranging from 8.0 μg/m³ (Xiwuqi) to 94.7 μg/m³ (Chengdu). Elevated PM_2.5 was associated with increased prevalence of hypertension (odds ratio (OR) =1.022, 95% confidence interval (95%CI): 1.001, 1.043) and decreased prevalence of overweight (OR = 0.926, 95%CI: 0.910, 0.942). Education significantly interacted with PM_2.5 in association with all the interesting risk factors. Each 10 μg/m³ increment of PM_2.5 was associated with increased prevalence of diabetes (OR = 1.118, 95%CI: 1.037, 1.206), hypertension (OR = 1.101, 95%CI: 1.056, 1.147), overweight (OR = 1.071, 95%CI: 1.030, 1.114) in participants with poor education, but not in well-educated population. PM_2.5 exposure was negatively associated with hyperlipidemia in all participants (OR = 0.939, 95%CI: 0.921, 0.957). The results were robust in all the sensitivity analyses.

CONCLUSION

Association between long-term PM_2.5 exposure and cardiovascular risk factors might be modified by education. PM_2.5 was associated with a higher prevalence of diabetes, hypertension, and overweight in a less-educated population with time-expose dependency. Long-term exposure to PM_2.5 might be associated with a lower prevalence of hyperlipidemia.

PM2.5 exposure as a risk factor for type 2 diabetes mellitus in the Mexico City metropolitan area

BACKGROUND

Exposure to air pollution is the main risk factor for morbidity and mortality in the world. Exposure to particulate matter with aerodynamic diameter ≤ 2.5 μm (PM2.5) is associated with cardiovascular and respiratory conditions, as well as with lung cancer, and there is evidence to suggest that it is also associated with type II diabetes (DM). The Mexico City Metropolitan Area (MCMA) is home to more than 20 million people, where PM2.5 levels exceed national and international standards every day. Likewise, DM represents a growing public health problem with prevalence around 12%. In this study, the objective was to evaluate the association between exposure to PM2.5 and DM in adults living in the MCMA.

METHODS

Data from the 2006 or 2012 National Health and Nutrition Surveys (ENSANUT) were used to identify subjects with DM and year of diagnosis. We estimated PM2.5 exposure at a residence level, based on information from the air quality monitoring system (monitors), as well as satellite measurements (satellite). We analyzed the relationship through a cross-sectional approach and as a case - control study.

RESULTS

For every 10 μg/m3 increase of PM2.5 we found an OR = 3.09 (95% CI 1.17-8.15) in the 2012 sample. These results were not conclusive for the 2006 data or for the case - control approach.

CONCLUSIONS

Our results add to the evidence linking PM2.5 exposure to DM in Mexican adults. Studies in low- and middle-income countries, where PM2.5 atmospheric concentrations exceed WHO standards, are required to strengthen the evidence.

Long-term impacts of ambient fine particulate matter exposure on overweight or obesity in Chinese adults: The China-PAR project

Although emerging researches have linked ambient fine particulate matter (PM2.5) to obesity, evidence from high-polluted regions is still lacking. We thus assessed the long-term impacts of PM2.5 on body mass index (BMI) and the risk of the prevalence of overweight/obesity (BMI≥25 kg/m2), by incorporating the well-established Prediction for Atherosclerotic Cardiovascular Disease Risk in China (China-PAR) project comprising 77,609 participants with satellite-based PM2.5 estimates at 1-km spatial resolution. The average of long-term PM2.5 level was 70.4 μg/m3, with the range of 32.1-94.2 μg/m3. Each 10 μg/m3 increment of PM2.5 was associated with 0.421 kg/m2 (95% confidence interval [CI]: 0.402, 0.439) and 13.5% (95% CI: 12.8%, 14.3%) increased BMI and overweight/obesity risk, respectively. Moreover, compared with the lowest quartile of PM2.5 (≤57.5 μg/m3), the relative risk of the prevalence of overweight/obesity from the highest quartile (>85.9 μg/m3) was 1.611 (95% CI: 1.566, 1.657). The exposure-response curve suggested a non-linear relationship between PM2.5 exposure and overweight/obesity. Besides, the association was modified by age, diabetes mellitus, hypertension and dyslipidemia status. Our study provides the evidence for the adverse impacts of long-term PM2.5 on BMI and overweight/obesity in China, and the findings are important for policy development on air quality, especially in severely polluted areas.

Association between long-term exposure to fine particulate matter and diabetic retinopathy among diabetic patients: A national cross-sectional study in China

BACKGROUND

While the relationship between ambient air pollution and diabetes mellitus has recently been reported, data on the association between fine particulate matter (PM_2.5) and diabetic complications are limited, especially in microvascular diseases such as diabetic retinopathy.

OBJECTIVES

To investigate the associations between long-term exposure to PM_2.5 and the prevalence of diabetic retinopathy in adult diabetic patients in rural China.

METHODS

The study population was based on the Rural Epidemiology for Glaucoma in China (REG-China), a national cross-sectional survey conducted in rural China. This analysis selected diabetic patients with or without diabetic retinopathy. A satellite-based spatiotemporal model was used to estimate personal PM_2.5 exposure. Logistic regression models were used to investigate the effect of long-term PM_2.5 exposure on diabetic retinopathy.

RESULTS

The analysis included 3111 diabetic participants, 329 of whom were diagnosed with diabetic retinopathy. The median level of exposure to PM_2.5 from 2000 to2016 was 59.9 μg/m³. For each 10 μg/m³ increase in PM_2.5, the adjusted odds ratio (95% confidence interval) for diabetic retinopathy was 1.41 (1.27, 1.57). In subgroup analyses, the effect of PM_2.5 on diabetic retinopathy was significantly stronger in participants who self-reported alcohol consumption.

CONCLUSION

These findings suggest that long-term exposure to high PM_2.5 was associated with the risk of diabetic retinopathy among diabetic patients in rural China.

Current status and distribution of hip fractures among older adults in China

China is a middle-risk country for hip fracture at present, which differs from previous data that it was low-risk. By 2050, the total number of hip fractures in people older than 65 years is predicted to be 1.3 million.

INTRODUCTION

To assess hip fracture incidence in China and examine the heterogeneity of hip fracture in seven geographical regions of China.

METHODS

There were 238,230 hip fracture patients aged 65 years or older from 2013 to 2016 from a large national in-patients database (HQMS) involving 30.6 million hospitalizations. Taking into account the total national hospitalization rate per calendar year, we estimated the incidence of hip fracture per 100,000 residents older than 65 years in China overall and in seven geographical Chinese regions.

RESULTS

The proportion of men and women older than 65 years with hip fractures was 1.00:1.95. Between 2013 and 2016, the number of hip fractures per 100,000 people age 65+ was 278. China has vast territories; the number of hip fractures per 100,000 people over 65 years old was 202 in Northeast China and 374 in Northwest China. Northwest has higher altitude, lower population density, is less developed with lower urbanization than Northeast China which is low altitude, and highly urbanized.

CONCLUSIONS

China should no longer be regarded as a low-risk country for hip fracture. By 2050, the total number of hip fractures in people older than 65 years in China is predicted to be 1.3 million. Higher altitude areas had higher hip fracture rates than lower altitude, higher urbanized areas.

Associations between serum amino acids and incident type 2 diabetes in Chinese rural adults

BACKGROUND AND AIMS

Some amino acids (AAs) may be associated with type 2 diabetes (T2DM). This study aimed to determine the associations of individual AAs with the development of T2DM in rural Chinese adults.

METHODS AND RESULTS

A cohort study of 1199 individuals aged 18 years or older was conducted from 2006 to 2008 in a rural community of Deqing, China, a repeated survey was done in 2015 and data linkage with the electronic health records system was performed each year for identifying new T2DM cases. A high-performance liquid chromatography approach was used to measure the baseline serum concentrations of 15 AAs. Cox proportional hazards models were used to examine the associations between AAs and the risk of incident T2DM. A total of 98 new T2DM cases were identified during the follow-up of 12 years on average. Among 15 AAs, proline was associated with an increased risk of incident T2DM after adjusted for age, sex, body mass index, fasting plasma glucose, family history of T2DM, smoking status, alcohol use, and history of hypertension, the adjusted hazard ratio for 1-standard deviation increment was 1.20 (95% confidence interval: 1.00, 1.43). The association tended to be more marked in subjects younger than 60 years and overweight/obese subjects. Among participants without hypertension, proline and phenylalanine were associated with an increased risk of incident T2DM, while aspartic acid was associated with a decreased risk.

CONCLUSION

Serum proline was associated with the risk of incident T2DM in rural Chinese adults and might be a potential predictor.

Acute effect of particulate matter pollution on hospital admissions for stroke among patients with type 2 diabetes in Beijing, China, from 2014 to 2018

BACKGROUND

The health effect of particulate matter pollution on stroke has been widely examined; however, the effect among patients with comorbid type 2 diabetes (T2D) in developing countries has remained largely unknown.

METHODS

A time-series study was conducted to investigate the short-term effect of fine particulate matter (PM_2.5) and inhalable particulate matter (PM₁₀) on hospital admissions for stroke among patients with T2D in Beijing, China, from 2014 to 2018. An over-dispersed Poisson generalized additive model was employed to adjust for important covariates, such as weather conditions and long-term and seasonal trends.

RESULTS

A total of 159,298 hospital admissions for stroke comorbid with T2D were reported. Approximately linear exposure-response curves were observed for PM_2.5 and PM₁₀ in relation to stroke admissions among T2D patients. A 10 μg/m³ increase in the four-day moving average of PM_2.5 and PM₁₀ was associated with 0.14% (95% confidence interval [CI]: 0.05-0.23%) and 0.14% (95% CI: 0.06-0.22%) incremental increases in stroke admissions among T2D patients, respectively. A 10 μg/m³ increase in PM_2.5 in the two-day moving average corresponded to a 0.72% (95% CI: 0.02-1.42%) incremental increase in hemorrhagic stroke, and a 10 μg/m³ increase in PM₁₀ in the four-day moving average corresponded to a 0.14% (95% CI: 0.06-0.22%) incremental increase in ischemic stroke.

CONCLUSIONS

High particulate matter might be a risk factor for stroke among patients with T2D. PM_2.5 and PM₁₀ have a linear exposure-response relationship with stroke among T2D patients. The study provided evidence of the risk of stroke due to particulate matter pollution among patients with comorbid T2D.

Regional Policies Targeting Residential Solid Fuel and Agricultural Emissions Can Improve Air Quality and Public Health in the Greater Bay Area and Across China

Air pollution exposure is a leading public health problem in China. The majority of the total air pollution disease burden is from fine particulate matter (PM2.5) exposure, with smaller contributions from ozone (O3) exposure. Recent emission reductions have reduced PM2.5 exposure. However, levels of exposure and the associated risk remain high, some pollutant emissions have increased, and some sectors lack effective emission control measures. We quantified the potential impacts of relevant policy scenarios on ambient air quality and public health across China. We show that PM2.5 exposure inside the Greater Bay Area (GBA) is strongly controlled by emissions outside the GBA. We find that reductions in residential solid fuel use and agricultural fertilizer emissions result in the greatest reductions in PM2.5 exposure and the largest health benefits. A 50% transition from residential solid fuel use to liquefied petroleum gas outside the GBA reduced PM2.5 exposure by 15% in China and 3% within the GBA, and avoided 191,400 premature deaths each year across China. Reducing agricultural fertilizer emissions of ammonia by 30% outside the GBA reduced PM2.5 exposure by 4% in China and 3% in the GBA, avoiding 56,500 annual premature deaths across China. Our simulations suggest that reducing residential solid fuel or industrial emissions will reduce both PM2.5 and O3 exposure, whereas other policies may increase O3 exposure. Improving particulate air quality inside the GBA will require consideration of residential solid fuel and agricultural sectors, which currently lack targeted policies, and regional cooperation both inside and outside the GBA.

Long-term exposure to ozone and sulfur dioxide increases the incidence of type 2 diabetes mellitus among aged 30 to 50 adult population

AIMS/HYPOTHESIS

Worldwide, the information regarding the associations between long-term exposure to ozone (O₃) and sulfur dioxide (SO₂) and the development of type 2 diabetes remains scarce, especially in Asia. This study aimed to investigate the long-term effects of exposure to ambient O₃ and SO₂ on the incidence of type 2 diabetes with consideration of other air pollutants in Taiwanese adults aged 30 to 50 years.

METHODS

A total of 6,426,802 non-diabetic participants aged between 30 and 50 years old were obtained from the National Health Insurance Research Database between 2005 and 2016. Incident type 2 diabetes was the main diagnosis at medical visits. Air quality data were provided by the Taiwan Environmental Protection Administration. The air pollutant concentrations for each participant were estimated using the ordinary kriging method to interpolate daily concentrations of O₃, SO₂, carbon monoxide (CO), nitrogen dioxide (NO₂), suspended fine particles (with an aerodynamic diameter less than 2.5 μm; PM_2.5), and suspended particles (with an aerodynamic diameter less than 10 μm; PM₁₀) in residential districts across Taiwan. Six-year average concentrations of pollutants were calculated from January 1, 2005 to December 31, 2010, and data were categorized into quartiles. We performed Cox regression models to analyze the long-term effects of exposure to O₃ and SO₂ on the incidence of type 2 diabetes.

RESULTS

The hazard ratio (HR) for the incidence of diabetes per each interquartile range (IQR) increase in ozone exposure (3.30 ppb) was 1.058 (95% confidence interval (CI): 1.053, 1.064) and 1.011 (95% CI: 1.007, 1.015) for SO₂ exposure (1.77 ppb) after adjusting for age, sex, socioeconomic status, urbanization level, temperature, humidity, and chronic comorbidities (Model 3). Furthermore, for every 3.30 ppb increase of O₃, the HR for incident type 2 diabetes was 1.093 (95% CI: 1.087, 1.100) after controlling factors shown in Model 3 plus SO₂ and PM_2.5. On the other hand, for every 1.77 ppb increase of SO₂, the HR for incident type 2 diabetes was 1.073 (95% CI: 1.068, 1.079) after controlling factors shown in Model 3 plus NO₂ and PM_2.5.

CONCLUSIONS

Long-term exposure to ambient O₃ and SO₂ was associated with a higher risk of developing type 2 diabetes for Taiwanese population. Exposure to O₃ and SO₂ may play a role in the adult early-onset type 2 diabetes.

Long-term air pollution exposure and self-reported morbidity: A longitudinal analysis from the Thai cohort study (TCS)

BACKGROUND

Several studies have shown the health effects of air pollutants, especially in China, North American and Western European countries. But longitudinal cohort studies focused on health effects of long-term air pollution exposure are still limited in Southeast Asian countries where sources of air pollution, weather conditions, and demographic characteristics are different. The present study examined the association between long-term exposure to air pollution and self-reported morbidities in participants of the Thai cohort study (TCS) in Bangkok metropolitan region (BMR), Thailand.

METHODS

This longitudinal cohort study was conducted for 9 years from 2005 to 2013. Self-reported morbidities in this study included high blood pressure, high blood cholesterol, and diabetes. Air pollution data were obtained from the Thai government Pollution Control Department (PCD). Particles with diameters ≤10 μm (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), ozone (O3), and carbon monoxide (CO) exposures were estimated with ordinary kriging method using 22 background and 7 traffic monitoring stations in BMR during 2005-2013. Long-term exposure periods to air pollution for each subject was averaged as the same period of person-time. Cox proportional hazards models were used to examine the association between long-term air pollution exposure with self-reported high blood pressure, high blood cholesterol, diabetes. Results of self-reported morbidity were presented as hazard ratios (HRs) per interquartile range (IQR) increase in PM10, O3, NO2, SO2, and CO.

RESULTS

After controlling for potential confounders, we found that an IQR increase in PM10 was significantly associated with self-reported high blood pressure (HR = 1.13, 95% CI: 1.04, 1.23) and high blood cholesterol (HR = 1.07, 95%CI: 1.02, 1.12), but not with diabetes (HR = 1.05, 95%CI: 0.91, 1.21). SO2 was also positively associated with self-reported high blood pressure (HR = 1.22, 95%CI: 1.08, 1.38), high blood cholesterol (HR = 1.20, 95%CI: 1.11, 1.30), and diabetes (HR = 1.21, 95%CI: 0.92, 1.60). Moreover, we observed a positive association between CO and self-reported high blood pressure (HR = 1.07, 95%CI: 1.00, 1.15), but not for other diseases. However, self-reported morbidities were not associated with O3 and NO2.

CONCLUSIONS

Long-term exposure to air pollution, especially for PM10 and SO2 was associated with self-reported high blood pressure, high blood cholesterol, and diabetes in subjects of TCS. Our study supports that exposure to air pollution increases cardiovascular disease risk factors for younger population.

Association between ambient air pollution and hyperuricemia in traffic police officers in China: a cohort study

To evaluate the association between ambient air pollution and hyperuricemia, we prospectively followed 1748 traffic police officers without hyperuricemia at baseline (2009-2014) from 11 districts in Guangzhou, China. We calculated six-year average PM₁₀, SO₂ and NO₂ concentrations using data collected from air monitoring stations. The hazard ratios for hyperuricemia per 10 µg/m³ increase in air pollutants were 1.46 (95% CI: 1.28-1.68) for PM₁₀, 1.23 (95% CI: 1.00-1.51) for SO₂, and 1.43 (95% CI: 1.26-1.61) for NO₂. We also identified changes in the ratio of serum uric acid to serum creatinine concentrations (ua/cre) per 10 µg/m³ increase in air pollutants as 11.54% (95% CI: 8.14%-14.93%) higher for PM₁₀, 5.09% (95% CI: 2.76%-7.42%) higher for SO₂, and 5.13% (95% CI: 2.35%-7.92%) higher for NO₂, respectively. Long-term exposure to ambient air pollution was associated with a higher incidence of hyperuricemia and an increase in ua/cre among traffic police officers.

Association between ambient particulate matter (PM10) and incidence of diabetes in northwest of China: A prospective cohort study

OBJECTIVES

We aimed to assess the association between long-term exposure to ambient PM₁₀ and risk of diabetes incidence, based on the "Jinchang Cohort" platform in the Northwest of China.

METHODS

We selected 19884 subjects who had not yet developed diabetes in the baseline and had completed survey information from "Jinchang Cohort". The residential address was used to match the nearest pollution monitoring station for each subject, and the average concentration of PM₁₀ from baseline to follow-up were used as an estimate of individual exposure level. Cox regression model and restricted cubic splines functions were used to evaluate the effects of PM₁₀ on the incidence of diabetes and the dose-response relationship after adjusting for confounding covariates.

RESULTS

We observed 791 new-onset diabetics with a total follow-up of 45254.16 person-years (incidence rate of 17.48 per 1000 person-years). The risk of diabetes incidence increased by 17% (HR = 1.17, 95%CI: 1.08-1.26) per 10μg/m³ increase in environmental PM₁₀, and the risk rises gradually with the rise of PM₁₀ concentration. Comparing with the first quartile of PM₁₀, the fully adjusted HRs (95%CI) for incident diabetes from the second to the fourth quartile of PM₁₀ were 1.15 (95%CI: 0.93-1.43), 1.50 (95%CI: 1.22-1.84) and 1.44 (95%CI: 1.15-1.79), respectively (P for trend<0.001). Stratified analyses suggested that the risk of diabetes incidence associated with ambient PM₁₀ was higher in female, young to middle-aged people, overweight and obese subjects, and subjects with FPG level at baseline lower than 5.6 mmol/L.

CONCLUSIONS

Long-term exposure to ambient PM₁₀ significantly associated with a higher risk of diabetes development. Some urgent strategies may be advocated to reduce air pollution that can aid in preventing the prevalence of diabetes in the population.

The 17-y spatiotemporal trend of PM2.5 and its mortality burden in China

Investigations on the chronic health effects of fine particulate matter (PM_2.5) exposure in China are limited due to the lack of long-term exposure data. Using satellite-driven models to generate spatiotemporally resolved PM_2.5 levels, we aimed to estimate high-resolution, long-term PM_2.5 and associated mortality burden in China. The multiangle implementation of atmospheric correction (MAIAC) aerosol optical depth (AOD) at 1-km resolution was employed as a primary predictor to estimate PM_2.5 concentrations. Imputation techniques were adopted to fill in the missing AOD retrievals and provide accurate long-term AOD aggregations. Monthly PM_2.5 concentrations in China from 2000 to 2016 were estimated using machine-learning approaches and used to analyze spatiotemporal trends of adult mortality attributable to PM_2.5 exposure. Mean coverage of AOD increased from 56 to 100% over the 17-y period, with the accuracy of long-term averages enhanced after gap filling. Machine-learning models performed well with a random cross-validation R ² of 0.93 at the monthly level. For the time period outside the model training window, prediction R ² values were estimated to be 0.67 and 0.80 at the monthly and annual levels. Across the adult population in China, long-term PM_2.5 exposures accounted for a total number of 30.8 (95% confidence interval [CI]: 28.6, 33.2) million premature deaths over the 17-y period, with an annual burden ranging from 1.5 (95% CI: 1.3, 1.6) to 2.2 (95% CI: 2.1, 2.4) million. Our satellite-based techniques provide reliable long-term PM_2.5 estimates at a high spatial resolution, enhancing the assessment of adverse health effects and disease burden in China.

Earth Observation Data Supporting Non-Communicable Disease Research: A Review

A disease is non-communicable when it is not transferred from one person to another. Typical examples include all types of cancer, diabetes, stroke, or allergies, as well as mental diseases. Non-communicable diseases have at least two things in common—environmental impact and chronicity. These diseases are often associated with reduced quality of life, a higher rate of premature deaths, and negative impacts on a countries’ economy due to healthcare costs and missing work force. Additionally, they affect the individual’s immune system, which increases susceptibility toward communicable diseases, such as the flu or other viral and bacterial infections. Thus, mitigating the effects of non-communicable diseases is one of the most pressing issues of modern medicine, healthcare, and governments in general. Apart from the predisposition toward such diseases (the genome), their occurrence is associated with environmental parameters that people are exposed to (the exposome). Exposure to stressors such as bad air or water quality, noise, extreme heat, or an overall unnatural surrounding all impact the susceptibility to non-communicable diseases. In the identification of such environmental parameters, geoinformation products derived from Earth Observation data acquired by satellites play an increasingly important role. In this paper, we present a review on the joint use of Earth Observation data and public health data for research on non-communicable diseases. We analyzed 146 articles from peer-reviewed journals (Impact Factor ≥ 2) from all over the world that included Earth Observation data and public health data for their assessments. Our results show that this field of synergistic geohealth analyses is still relatively young, with most studies published within the last five years and within national boundaries. While the contribution of Earth Observation, and especially remote sensing-derived geoinformation products on land surface dynamics is on the rise, there is still a huge potential for transdisciplinary integration into studies. We see the necessity for future research and advocate for the increased incorporation of thematically profound remote sensing products with high spatial and temporal resolution into the mapping of exposomes and thus the vulnerability and resilience assessment of a population regarding non-communicable diseases.

PM2.5 downregulates MicroRNA-139-5p and induces EMT in Bronchiolar Epithelium Cells by targeting Notch1

PM2.5 was closely linked to lung cancer worldwide. However, the mechanism involved in PM2.5 induced lung cancer is still largely unknown. In this study, we performed chronic PM2.5 stimulation animal and cells model to investigate the carcinogenetic mechanisms of PM2.5 by targeting EMT through Notch1 signal pathway. Next, we focused on the miRNA involved in PM2.5 induced Notch1 pathway activation. We found chronic PM2.5 could induce EMT event in vivo and in vitro, while reducing miR-139-5p expression and activating Notch1 pathway meanwhile. And blocking Notch1 signal pathway by specific small molecule inhibitor could reverse PM2.5 induced EMT. Then, overexpression of miR-139-5p downregulated the expression of Notch1 protein in untreated 16HBE cells. Importantly, overexpression of miR-139-5p blocked Notch1 pathway activation and inhibited EMT event in PM2.5 treated cells. These results indicate that PM2.5 induces EMT event through Notch1 signal pathway and miR-139-5p is a novel regulator of PM2.5-induced EMT by targeting Notch1. Our conclusion is that overexpression of miR-139-5p can down-regulate the expression of Notch1 and reverse the occurrence of malignant lung events induced by chronic exposure to PM2.5.

Exposure to particulate matter (PM2.5) and prevalence of diabetes mellitus in Indonesia

BACKGROUND

Recently emerging evidence suggests an association between particulate matter less than 2.5 µm in diameter (PM_2.5) exposure and diabetes risk. However, evidence from Asia is limited. Here, we evaluated the association between PM_2.5 exposure and the prevalence of diabetes mellitus in one of the most populated countries in Asia, Indonesia.

METHODS

We used the 2013 Indonesia Basic Health Research, which surveyed households in 487 regencies/municipalities in all 33 provinces in Indonesia (n = 647,947). We assigned individual exposure to PM_2.5 using QGIS software. Multilevel logistic regression with a random intercept based on village and cubic spline analysis were used to assess the association between PM_2.5 exposure and the prevalence of diabetes mellitus. We also assessed the lower exposure at which PM_2.5 has potential adverse effects.

RESULTS

We included 647,947 subjects with a mean age of 41.9 years in our study. Exposure to PM_2.5 levels was associated with a 10-unit increase in PM_2.5 (fully adjusted odds ratio: 1.09; 95% confidence interval: 1.05-1.14). The findings were consistent for quartile increases in PM_2.5 levels and the cubic spline function. Even when we restricted to those exposed to PM_2.5 concentrations of less than 10.0 µg/m³ in accordance with the recommended guidelines for annual exposure to PM_2.5 made by the World Health Organization, the association remained elevated, especially among subjects living in the urban areas. Hence, we were unable to establish a safe threshold for PM_2.5 and the risk of diabetes.

CONCLUSIONS

Our findings suggest a positive association between PM_2.5 exposure and prevalence of diabetes mellitus, which is possibly below the current recommended guidelines. Further studies are needed to ascertain the causal association of this finding.