Association between fine particulate matter and diabetes prevalence in the U.S

Abstract

Objective: Recent studies have drawn attention to the adverse effects of ambient air pollutants such as particulate matter 2.5 (PM2.5) on human health. We evaluated the association between PM2.5 exposure and diabetes prevalence in the U.S. and explored factors that may influence this relationship.

Research design and methods: The relationship between PM2.5 levels and diagnosed diabetes prevalence in the U.S. was assessed by multivariate regression models at the county level using data obtained from both the Centers for Disease Control and Prevention (CDC) and U.S. Environmental Protection Agency (EPA) for years 2004 and 2005. Covariates including obesity rates, population density, ethnicity, income, education, and health insurance were collected from the U.S. Census Bureau and the CDC.

Results: Diabetes prevalence increases with increasing PM2.5 concentrations, with a 1% increase in diabetes prevalence seen with a 10 μg/m(3) increase in PM2.5 exposure (2004: β = 0.77 [95% CI 0.39-1.25], P < 0.001; 2005: β = 0.81 [0.48-1.07], P < 0.001). This finding was confirmed for each study year in both univariate and multivariate models. The relationship remained consistent and significant when different estimates of PM2.5 exposure were used. Even for counties within guidelines for EPA PM2.5 exposure limits, those with the highest exposure showed a >20% increase in diabetes prevalence compared with that for those with the lowest levels of PM2.5, an association that persisted after controlling for diabetes risk factors.

Conclusions: Our results suggest PM2.5 may contribute to increased diabetes prevalence in the adult U.S. population. These findings add to the growing evidence that air pollution is a risk factor for diabetes.

Figure 1

A: 2005 Diabetes prevalence and PM2.5 annual mean concentration for U.S. counties: diabetes prevalence quartiles (left) and PM2.5 annual mean concentration quartiles (right) for all contiguous U.S. counties. B: Diabetes prevalence rates per each quartile of PM2.5 for counties within the EPA PM2.5 limit (<15 μg/m³), using the 36-km PM2.5 model. The data are unadjusted for the previously mentioned covariates. Diabetes prevalence values are labeled on each bar. The quartile cut points for PM2.5 are listed in the table on the x-axis. *Statistically significant result: P < 0.05.