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Risk of incident diabetes in relation to long-term exposure to fine particulate matter in Ontario, Canada


Background — Laboratory studies suggest that fine particulate matter (2.5µm in diameter or less; PM2.5) can activate pathophysiological responses which may induce insulin resistance and type-2 diabetes. However, epidemiological evidence relating PM2.5 and diabetes is sparse, particularly for incident diabetes.

Objectives — The researchers conducted a population-based cohort study to determine whether long-term exposure to ambient PM2.5 is associated with incident diabetes.

Methods — The researchers assembled a cohort of 62,012 nondiabetic adults who lived in Ontario, Canada and completed one of five population-based health surveys between 1996 and 2005. Follow-up extended until December 31, 2010. Incident diabetes diagnosed between 1996 and 2010 was ascertained using the Ontario Diabetes Database, a validated registry of persons diagnosed with diabetes (sensitivity=86%, specificity=97%). Six-year average concentrations of PM2.5 at the postal codes of baseline residences were derived from satellite observations. The researchers used Cox proportional hazards models to estimate the associations, adjusting for various individual-level risk factors and contextual covariates such as smoking, body mass index, physical activity, and neighbourhood-level household income. The researchers also conducted multiple sensitivity analyses. In addition, the researchers examined effect modification for selected comorbidities and sociodemographic characteristics.

Results — There were 6,310 incident cases of diabetes over 484,644 total person-years of follow up. The adjusted hazard ratio for a 10-µg/m3 increase in PM2.5 was 1.11 (95% CI: 1.02, 1.21). Estimated associations were comparable among all sensitivity analyses. The researchers did not find strong evidence of effect modification by comorbidities or sociodemographic covariates.

Conclusions — This study suggests that long-term exposure to PM2.5 may contribute to the development of diabetes.



Chen H, Burnett RT, Kwong JC, Villeneuve PJ, Goldberg MS, Brook RD, van Donkelaar A, Jerrett M, Martin RV, Brook JR, Copes R. Environ Health Perspect. 2013; 121(7):804-10. Epub 2013 Apr 26.

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