Longitudinal relationship of particulate matter and metabolic control and severe hypoglycaemia in children and adolescents with type 1 diabetes

The Impact of Long-Term Air Pollution Exposure on Type 1 Diabetes Mellitus-Related Mortality among U.S. Medicare Beneficiaries

BACKGROUND

Little of the previous literature has investigated associations between air pollution exposure and type 1 diabetes mellitus (T1DM)-related mortality, despite a well-established link between air pollution exposure and other autoimmune diseases.

METHODS

In a cohort of 53 million Medicare beneficiaries living across the conterminous United States, we used Cox proportional hazard models to assess the association of long-term PM_2.5 and NO₂ exposures on T1DM-related mortality from 2000 to 2008. Models included strata for age, sex, race, and ZIP code and controlled for neighborhood socioeconomic status (SES); we additionally investigated associations in two-pollutant models, and whether associations were modified by participant demographics.

RESULTS

A 10 μg/m³ increase in 12-month average PM_2.5 (HR: 1.183; 95% CI: 1.037-1.349) and a 10 ppb increase in NO₂ (HR: 1.248; 95% CI: 1.089-1.431) was associated with an increased risk of T1DM-related mortality in age-, sex-, race-, ZIP code-, and SES-adjusted models. Associations for both pollutants were consistently stronger among Black (PM_2.5: HR:1.877, 95% CI: 1.386-2.542; NO₂: HR: 1.586, 95% CI: 1.258-2.001) and female (PM_2.5: HR:1.297, 95% CI: 1.101-1.529; NO₂: HR: 1.390, 95% CI: 1.187-1.627) beneficiaries.

CONCLUSIONS

Long-term NO₂ and, to a lesser extent, PM_2.5 exposure is associated with statistically significant elevations in T1DM-related mortality risk.

Air Pollution, Oxidative Stress, and the Risk of Development of Type 1 Diabetes

Despite multiple studies focusing on environmental factors conducive to the development of type 1 diabetes mellitus (T1DM), knowledge about the involvement of long-term exposure to air pollution seems insufficient. The main focus of epidemiological studies is placed on the relationship between exposure to various concentrations of particulate matter (PM): PM1, PM2.5, PM10, and sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (O3), versus the risk of T1DM development. Although the specific molecular mechanism(s) behind the link between increased air pollution exposure and a higher risk of diabetes and metabolic dysfunction is yet unknown, available data indicate air pollution-induced inflammation and oxidative stress as a significant pathway. The purpose of this paper is to assess recent research examining the association between inhalation exposure to PM and associated metals and the increasing rates of T1DM worldwide. The development of modern and more adequate methods for air quality monitoring is also introduced. A particular emphasis on microsensors, mobile and autonomous measuring platforms, satellites, and innovative approaches of IoT, 5G connections, and Block chain technologies are also presented. Reputable databases, including PubMed, Scopus, and Web of Science, were used to search for relevant literature. Eligibility criteria involved recent publication years, particularly publications within the last five years (except for papers presenting a certain novelty or mechanism for the first time). Population, toxicological and epidemiological studies that focused particularly on fine and ultra-fine PM and associated ambient metals, were preferred, as well as full-text publications.

Is Population Density Associated with Non-Communicable Disease in Western Developed Countries? A Systematic Review

Over the last three decades, researchers have investigated population density and health outcomes at differing scale. There has not been a systematic review conducted in order to synthesise this evidence. Following the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines, we systematically reviewed quantitative evidence published since 1990 on population density and non-communicable disease (NCD) within Westernised countries. Fifty-four studies met the inclusion criteria and were evaluated utilising a quality assessment tool for ecological studies. High population density appears to be associated with higher mortality rates of a range of cancers, cardiovascular disease and COPD, and a higher incidence of a range of cancers, asthma and club foot. In contrast, diabetes incidence was found to be associated with low population density. High and low population density are therefore risk markers for a range of NCDs, indicating that there are unidentified factors and mechanisms underlying aetiology. On closer examination, our synthesis revealed important and complex relationships between population density, the built environment, the nature of greenspace and man-made exposures. In light of increasing rates of morbidity and mortality, future research is required to investigate these associations in order to establish causative agents for each NCD.