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McAlexander TP, Ryan V, Uddin J, Kanchi R, Thorpe L, Schwartz BS, Carson A, Rolka DB, Adhikari S, Pollak J, Lopez P, Smith M, Meeker M, McClure LA. Associations between PM 2.5 and O 3 exposures and new onset type 2 diabetes in regional and national samples in the United States. ENVIRONMENTAL RESEARCH 2023; 239:117248. [PMID: 37827369 DOI: 10.1016/j.envres.2023.117248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 09/07/2023] [Accepted: 09/09/2023] [Indexed: 10/14/2023]
Abstract
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.
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Affiliation(s)
- Tara P McAlexander
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA.
| | - Victoria Ryan
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Jalal Uddin
- Department of Epidemiology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rania Kanchi
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Lorna Thorpe
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Brian S Schwartz
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - April Carson
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, 39213, USA
| | - Deborah B Rolka
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Samrachana Adhikari
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Jonathan Pollak
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Priscilla Lopez
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Megan Smith
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Melissa Meeker
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Leslie A McClure
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
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Mainka A, Żak M. Synergistic or Antagonistic Health Effects of Long- and Short-Term Exposure to Ambient NO 2 and PM 2.5: A Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192114079. [PMID: 36360958 PMCID: PMC9657687 DOI: 10.3390/ijerph192114079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/24/2022] [Accepted: 10/26/2022] [Indexed: 05/31/2023]
Abstract
Studies on adverse health effects associated with air pollution mostly focus on individual pollutants. However, the air is a complex medium, and thus epidemiological studies face many challenges and limitations in the multipollutant approach. NO2 and PM2.5 have been selected as both originating from combustion processes and are considered to be the main pollutants associated with traffic; moreover, both elicit oxidative stress responses. An answer to the question of whether synergistic or antagonistic health effects of combined pollutants are demonstrated by pollutants monitored in ambient air is not explicit. Among the analyzed studies, only a few revealed statistical significance. Exposure to a single pollutant (PM2.5 or NO2) was mostly associated with a small increase in non-accidental mortality (HR:1.01-1.03). PM2.5 increase of <10 µg/m3 adjusted for NO2 as well as NO2 adjusted for PM2.5 resulted in a slightly lower health risk than a single pollutant. In the case of cardiovascular heart disease, mortality evoked by exposure to PM2.5 or NO2 adjusted for NO2 and PM2.5, respectively, revealed an antagonistic effect on health risk compared to the single pollutant. Both short- and long-term exposure to PM2.5 or NO2 adjusted for NO2 and PM2.5, respectively, revealed a synergistic effect appearing as higher mortality from respiratory diseases.
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