Honda TJ, Kazemiparkouhi F, Suh H. The Impact of Long-Term Air Pollution Exposure on Type 1 Diabetes Mellitus-Related Mortality among U.S. Medicare Beneficiaries.
TOXICS 2023;
11:336. [PMID:
37112563 PMCID:
PMC10145417 DOI:
10.3390/toxics11040336]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 03/22/2023] [Accepted: 03/30/2023] [Indexed: 06/19/2023]
Abstract
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 PM2.5 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 PM2.5 (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 (PM2.5: HR:1.877, 95% CI: 1.386-2.542; NO2: HR: 1.586, 95% CI: 1.258-2.001) and female (PM2.5: 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, PM2.5 exposure is associated with statistically significant elevations in T1DM-related mortality risk.
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