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. 2022 Jul;6(7):e586-e600.
doi: 10.1016/S2542-5196(22)00122-X.

Estimates, trends, and drivers of the global burden of type 2 diabetes attributable to PM2·5 air pollution, 1990-2019: an analysis of data from the Global Burden of Disease Study 2019

GBD 2019 Diabetes and Air Pollution Collaborators
Collaborators

Estimates, trends, and drivers of the global burden of type 2 diabetes attributable to PM2·5 air pollution, 1990-2019: an analysis of data from the Global Burden of Disease Study 2019

GBD 2019 Diabetes and Air Pollution Collaborators. Lancet Planet Health. 2022 Jul.

Abstract

Background: Experimental and epidemiological studies indicate an association between exposure to particulate matter (PM) air pollution and increased risk of type 2 diabetes. In view of the high and increasing prevalence of diabetes, we aimed to quantify the burden of type 2 diabetes attributable to PM2·5 originating from ambient and household air pollution.

Methods: We systematically compiled all relevant cohort and case-control studies assessing the effect of exposure to household and ambient fine particulate matter (PM2·5) air pollution on type 2 diabetes incidence and mortality. We derived an exposure-response curve from the extracted relative risk estimates using the MR-BRT (meta-regression-Bayesian, regularised, trimmed) tool. The estimated curve was linked to ambient and household PM2·5 exposures from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019, and estimates of the attributable burden (population attributable fractions and rates per 100 000 population of deaths and disability-adjusted life-years) for 204 countries from 1990 to 2019 were calculated. We also assessed the role of changes in exposure, population size, age, and type 2 diabetes incidence in the observed trend in PM2·5-attributable type 2 diabetes burden. All estimates are presented with 95% uncertainty intervals.

Findings: In 2019, approximately a fifth of the global burden of type 2 diabetes was attributable to PM2·5 exposure, with an estimated 3·78 (95% uncertainty interval 2·68-4·83) deaths per 100 000 population and 167 (117-223) disability-adjusted life-years (DALYs) per 100 000 population. Approximately 13·4% (9·49-17·5) of deaths and 13·6% (9·73-17·9) of DALYs due to type 2 diabetes were contributed by ambient PM2·5, and 6·50% (4·22-9·53) of deaths and 5·92% (3·81-8·64) of DALYs by household air pollution. High burdens, in terms of numbers as well as rates, were estimated in Asia, sub-Saharan Africa, and South America. Since 1990, the attributable burden has increased by 50%, driven largely by population growth and ageing. Globally, the impact of reductions in household air pollution was largely offset by increased ambient PM2·5.

Interpretation: Air pollution is a major risk factor for diabetes. We estimated that about a fifth of the global burden of type 2 diabetes is attributable PM2·5 pollution. Air pollution mitigation therefore might have an essential role in reducing the global disease burden resulting from type 2 diabetes.

Funding: Bill & Melinda Gates Foundation.

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Conflict of interest statement

Declaration of interests T W Bärnighausen reports support for the present manuscript from the Alexander von Humboldt Foundation, Wellcome Trust, German Research Foundation, and US National Institutes of Health (National Institute of Allergy and Infectious Diseases, National Institute on Aging, and Fogarty International Center), all paid to his institution. Y Béjot reports consulting fees from Novo Nordisk and honoraria for lectures from Medtronic, Boehringer Ingelheim, Pfizer, Bristol Myers Squibb (BMS), Servier Laboratories, and Amgen, all outside the submitted work. L A Càmera reports non-financial support for the present manuscript from Sociedad Argentina de Medicina and Hospital Italiano Buenos Aires. X Dai reports support for the present manuscript via salary from the Institute for Health Metrics and Evaluation University of Washington. I Filip and A Radfar report support from Avicenna Medical and Clinical Research Institute, outside the submitted work. J J Jozwiak reports payment via personal fees for lectures, presentations, speaker's bureaus, manuscript writing or educational events from Teva Pharmaceuticals, Amgen, Synexus, Boehringer Ingelheim, Zentiva, and Sanofi, all outside the submitted work. M Kivimäki reports research grants to University College London (London, UK) from the Wellcome Trust (221854/Z/20/Z) and the UK Medical Research Council (MR/S011676/1), outside the submitted work. S Lorkowski reports (all outside the submitted work) grants or contracts paid to his institution from Akcea Therapeutics Germany; consulting fees from Danone, Novartis Pharma, Swedish Orphan Biovitrum (SOBI), and Upfield; payment or honoraria for lectures, presentations, speaker's bureaus, manuscript writing, or educational events from Akcea Therapeutics Germany, Amarin Germany, Amedes Holding, Amgen, Berlin-Chemie, Boehringer Ingelheim, Daiichi Sankyo Deutschland, Danone, Hubert Burda Media Holding, Janssen-Cilag, Lilly Deutschland, Novartis, Novo Nordisk, F Hoffmann-La Roche (Roche), Sanofi-Aventis, SYNLAB Holding Deutschland, and SYNLAB Akademie; support for attending meetings or travel from Amgen; and participation on a data safety monitoring board or advisory board for Akcea Therapeutics Germany, Amgen, Daiichi Sankyo Deutschland, Novartis, and Sanofi-Aventis. P W Mahasha reports (all outside the submitted work) participation on a data safety monitoring board or advisory board as a member of the Technical Advisory Panel to the Office of Health Standards Compliance and Health Ombud from Feb 12, 2020, to Feb 11, 2022, and leadership or fiduciary roles in boards, societies, committees, or advocacy groups, paid or unpaid, as a member of the Federation of Infectious Diseases Societies of Southern Africa since November, 2021; the EU-Africa PerMed Consortium from February, 2021, to January, 2025; the South African Society for Biochemistry and Molecular Biology since August, 2021; the International Society for Infectious Diseases since November, 2021; the South African Society of Microbiology since November, 2021; the COVID-19 Clinical Research Coalition since August, 2021; the Scholars Academic and Scientific Society since August, 2021; Cochrane International since October, 2019 (renewed on March 13, 2022); and the South African Council for Natural Scientific Professions since June, 2018. A Ortiz reports (all outside the submitted work) grants from Sanofi; consultancy or speaker fees or travel support from Advicenne, Astellas, AstraZeneca, Amicus, Amgen, Fresenius Medical Care, GlaxoSmithKline, Bayer, Sanofi-Genzyme, Menarini, Kyowa Kirin, Alexion, Idorsia, Chiesi, Otsuka, Novo-Nordisk, and Vifor Fresenius Medical Care Renal Pharma; is Director of the Catedra Mundipharma-UAM of diabetic kidney disease and the Catedra AstraZeneca-UAM of chronic kidney disease and electrolytes; is the Editor-in-Chief for Clinical Kidney Journal; and reports a leadership or fiduciary role with the European Renal Association and Madrid Renal Association. P A Mahesh reports grants or contracts paid to his institution from the Government of India (Wellcome Trust/DBT team science grant), the US National Institutes of Health Global Infectious Diseases, and the Swedish Heart Lung Foundation, outside the submitted work. M J Postma reports grants paid to his institution from Boehringer Ingelheim and AstraZeneca, and stock or stock options in Health-Ecore (25%) and Pharmacoeconomics Advice Groningen (100%), all outside the submitted work. J Sanabria reports a pending patent for pNaKtide, and leadership or fiduciary roles in boards, societies, committees, or advocacy groups, paid or unpaid with the Society for the Surgery of the Alimentary Tract, American Association for the Study of Liver Diseases, Society of University Surgeons, and American Society of Transplant Surgeons, all outside the submitted work. P R Valdez reports support for the present manuscript from Sociedad Argentina de Medicina and Hospital Velez Sarsfield Buenos Aires. All other authors declare no competing interests.

Figures

Figure 1
Figure 1
Exposure–response function for PM2·5 exposure and type 2 diabetes for an exposure range of 0–100 μg/m3 (A) and 0-500 μg/m3 (B) The solid line shows the central estimate of the exposure–response curve, and the shaded area depicts 95% uncertainty intervals. The relative risk equals 1 for PM2·5 concentrations of 0–2·4 μg/m3, which corresponds to the lower bound of the theoretical minimum risk exposure level uncertainty distribution. Each point represents an epidemiological study included in the model. The size of the point reflects the inverse variance used to weight the model. The relative risk axis is on a log scale. PM=particulate matter.
Figure 2
Figure 2
Spatial distribution of the PAF of type 2 diabetes DALYs at all ages and in both sexes attributable to PM2·5 air pollution, 2019 Maps show the PAF of type 2 diabetes DALYs at all ages and in both sexes in 2019 that was due to PM2·5 air pollution (A), ambient PM2·5 pollution (B), and household air pollution from solid fuels (C). DALYs=disability-adjusted life-years. PAF=population attributable fraction. PM=particulate matter.
Figure 2
Figure 2
Spatial distribution of the PAF of type 2 diabetes DALYs at all ages and in both sexes attributable to PM2·5 air pollution, 2019 Maps show the PAF of type 2 diabetes DALYs at all ages and in both sexes in 2019 that was due to PM2·5 air pollution (A), ambient PM2·5 pollution (B), and household air pollution from solid fuels (C). DALYs=disability-adjusted life-years. PAF=population attributable fraction. PM=particulate matter.
Figure 3
Figure 3
Temporal trend in the type 2 diabetes burden attributable to air pollution, ambient particulate matter pollution, and household air pollution from solid fuels, 1990–2019 Data are for all ages and both sexes by GBD super-region and globally. DALYs=disability-adjusted life-years. GBD=Global Burden of Diseases, Injuries, and Risk Factors Study. PAF=population attributable fraction. PM=particulate matter.
Figure 4
Figure 4
Drivers of trends in type 2 diabetes DALYs attributable to air pollution in GBD super-regions and globally, 1990–2019 Data are for all ages and both sexes. The PM2·5 pollution-deleted DALY rate is the expected rate if air pollution were reduced to the theoretical minimum risk exposure level and captures changes in other risk factors or treatment practices. DALYs=disability-adjusted life-years. GBD=Global Burden of Diseases, Injuries, and Risk Factors Study. PM=particulate matter.
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