The association of PM2.5 and ozone with diabetes mellitus prevalence in the United States, 2002-2008
Diabetes mellitus (DM) is a leading cause of death in the United States (U.S.) and adversely impacts both individuals and the nation’s economy. While there are many known risk factors for DM, exploring additional risk factors for DM is necessary to reduce the prevalence of the disease. This study examined the association between PM2.5 and ozone with DM prevalence in the U.S. between 2002 and 2008. This was a semi-ecologic study that used annual average, county-level exposure data from the CDC’s National Public Health Tracking Network (Tracking Network) and cross-sectional, individual-level outcome and covariate data from the Selected Metropolitan/Micropolitan Area Risk Trends of Behavioral Risk Factor Surveillance System (SMART BRFSS). Unweighted and weighted associations between PM2.5 and ozone with DM among SMART BRFSS counties by the four U.S. regions (Northeast, Midwest, South, West) were analyzed. Final analysis included 863,096 individuals and the results are presented in change in prevalence of DM per 10-unit increase in annual average county-level PM2.5 (μg/m3) or ozone (parts per billion, ppb) concentration estimates. This study found statistically significant associations between PM2.5 and ozone with DM after adjusting for confounders in the final unweighted model (PM 2.5: prevalence ratio (PR)=1.13; 95% Confidence Interval (CI)=1.07, 1.20; ozone: PR=1.04; 95% CI=1.01, 1.07). Using the final weighted model, the association between PM2.5 and DM was attenuated (PR=1.05; 95% CI=0.99, 1.12) while the association between ozone and DM remained (PR=1.07; 95% CI=1.03, 1.11). Regional variations in the association between PM 2.5 and ozone with DM using the final unweighted and weighted models were also found with the strongest association for PM2.5 and DM in the Midwest (unweighted PR=1.24; 95% CI=1.13, 1.36; weighted PR=1.23; 95% CI=1.03, 1.46), and for ozone and DM being in the Northeast (unweighted PR=1.12; 95% CI=1.03, 1.21; weighted PR=1.15; 95% CI=1.03, 1.28). In summary, this study found that per every 10-unit increase in annual average county-level concentration estimates of PM2.5 and ozone, prevalence of DM increased between 5% to 7% and these associations varied by U.S. region. These findings suggest that interventions in reducing exposures to PM2.5 and ozone could help reduce the DM burden.^
Hernandez, Ashley, "The association of PM2.5 and ozone with diabetes mellitus prevalence in the United States, 2002-2008" (2016). Texas Medical Center Dissertations (via ProQuest). AAI10183275.