Ambient air pollution and hospitalization for type 2 diabetes in China: A nationwide, individual-level case-crossover study

Huihuan Luo; Cong Liu; Xiyin Chen; Jian Lei; Yixiang Zhu; Lu Zhou; Ya Gao; Xia Meng; Haidong Kan; Jianwei Xuan; Renjie Chen

doi:10.1016/j.envres.2022.114596

Ambient air pollution and hospitalization for type 2 diabetes in China: A nationwide, individual-level case-crossover study

Environ Res. 2023 Jan 1;216(Pt 2):114596. doi: 10.1016/j.envres.2022.114596. Epub 2022 Oct 19.

Authors

Huihuan Luo¹, Cong Liu¹, Xiyin Chen², Jian Lei¹, Yixiang Zhu¹, Lu Zhou¹, Ya Gao¹, Xia Meng¹, Haidong Kan¹, Jianwei Xuan³, Renjie Chen⁴

Affiliations

¹ School of Public Health, Shanghai Institute of Infectious Disease and Biosecurity, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, 200032, China.
² Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
³ Health Economic Research Institute, School of Pharmacy, Sun Yat-Shen University, GuangZhou, 510275, China. Electronic address: xuanjw3@sysu.edu.cn.
⁴ School of Public Health, Shanghai Institute of Infectious Disease and Biosecurity, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, 200032, China. Electronic address: chenrenjie@fudan.edu.cn.

PMID: 36272593
DOI: 10.1016/j.envres.2022.114596

Abstract

Scarce evidence is available on the short-term association between air pollution and type 2 diabetes (T2D). We aimed to evaluate the associations between short-term exposure to six criteria air pollutants and hospitalization for T2D based on a national registry. We conducted an individual-level, time-stratified case-crossover study among inpatients with a primary diagnosis of T2D from 153 hospitals across 20 provincial regions in China (2013-2021). Daily concentrations of fine particulate matter (PM_2.5), inhalable particle (PM₁₀), nitrogen dioxide (NO₂), sulfur dioxide (SO₂) and carbon monoxide (CO), and ozone were collected from the nearest monitoring stations. T2D patients were separated into those admission for T2D with and without complications. Distributed lag non-linear models combined with conditional logistic regressions were used to estimate the associations. A total of 88,904 patients were hospitalized for T2D. Short-term exposures to all six air pollutants above except for ozone were significantly associated with the risk of hospitalization for T2D and both subclasses. An interquartile range increase in the concentrations of PM_2.5, PM₁₀, NO₂, SO₂, and CO at lag 0-2 d was associated with higher hospitalization risk of T2D by 1.71% (95%CI: 0.56%, 2.87%), 2.08% (0.88%, 3.29%), 4.85% (3.29%, 6.44%), 2.44% (1.22%, 3.67%) and 2.55% (1.24%, 3.88%), respectively. The associations of T2D hospitalizations were stronger in cold season than in warm season. Air pollutants had more acute and stronger associations with T2D with complications. The exposure-response relationship curves showed no thresholds, and the slopes were larger for T2D with complications. This nationwide individual-level, case-crossover study provides the first comprehensive evidence that short-term exposure to multiple criteria air pollutants may increase the risk of hospitalizations for T2D, especially for T2D with complications.

Keywords: Air pollutants; Case-crossover study; Diabetic complications; Hospitalization; Short-term exposure; Type 2 diabetes.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Air Pollutants* / analysis
Air Pollutants* / toxicity
Air Pollution* / adverse effects
Air Pollution* / analysis
China / epidemiology
Cross-Over Studies
Diabetes Mellitus, Type 2* / epidemiology
Hospitalization
Humans
Nitrogen Dioxide / analysis
Ozone* / analysis
Particulate Matter / analysis
Sulfur Dioxide / analysis

Substances

Nitrogen Dioxide
Air Pollutants
Particulate Matter
Sulfur Dioxide
Ozone