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. 2014 Sep;22(9):2080-90.
doi: 10.1002/oby.20800. Epub 2014 May 28.

Inverse association between diabetes and altitude: a cross-sectional study in the adult population of the United States

Orison O Woolcott  1 , Oscar A Castillo, Cesar Gutierrez, Robert M Elashoff, Darko Stefanovski, Richard N Bergman
Affiliations

Inverse association between diabetes and altitude: a cross-sectional study in the adult population of the United States

Orison O Woolcott et al. Obesity (Silver Spring). 2014 Sep.

Abstract

Objective: To determine whether geographical elevation is inversely associated with diabetes, while adjusting for multiple risk factors.

Methods: This is a cross-sectional analysis of publicly available online data from the Behavioral Risk Factor Surveillance System, 2009. Final dataset included 285,196 US adult subjects. Odds ratios were obtained from multilevel mixed-effects logistic regression analysis.

Results: Among US adults (≥20 years old), the odds ratio for diabetes was 1.00 between 0 and 499 m of altitude (reference), 0.95 (95% confidence interval, 0.90-1.01) between 500 and 1,499 m, and 0.88 (0.81-0.96) between 1,500 and 3,500 m, adjusting for age, sex, body mass index, ethnicity, self-reported fruit and vegetable consumption, self-reported physical activity, current smoking status, level of education, income, health status, employment status, and county-level information on migration rate, urbanization, and latitude. The inverse association between altitude and diabetes in the US was found among men [0.84 (0.76-0.94)], but not women [1.09 (0.97-1.22)].

Conclusions: Among US adults, living at high altitude (1,500-3,500 m) is associated with lower odds of having diabetes than living between 0 and 499 m, while adjusting for multiple risk factors. Our findings suggest that geographical elevation may be an important factor linked to diabetes.

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Figures

Figure 1
Figure 1
Correlation between altitude and county-level prevalence of self-reported obesity and diabetes among US adults. Data of obesity prevalence (A) and diabetes prevalence (B) where age-adjusted and corresponded to estimates from the Centers for Disease Control and Prevention for 2009. Associations were estimated using Spearman rank order correlation.
Figure 2
Figure 2
Trends of age-adjusted prevalences of obesity (A) and diabetes (B) among US adults aged 20 years or older from low- and high-altitude counties. Plots and bars represent median and interquartile range, respectively. In the insets showing the prevalence of obesity and diabetes as a function of altitude, lines represent the non-linear (third-order polynomial) fit of the plots.
See this image and copyright information in PMC

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