Secular trends in global burden of diabetes attributable to particulate matter pollution from 1990 to 2019

The burden of type 2 diabetes attributable to air pollution across China and its provinces, 1990-2021: an analysis for the Global Burden of Disease Study 2021

Background

Temporal trends and geographical disparities in type 2 diabetes burden attributable to air pollution, including ambient and household, are not fully understood within China. This study aims to estimate the burden of type 2 diabetes attributable to air pollution at national and provincial levels from 1990 to 2021.

Methods

We assessed air pollution exposure across 33 Chinese provinces, autonomous regions, municipalities, and special administrative regions, focusing on two common forms of air pollution: ambient particulate matter pollution (defined as the annual gridded concentration of PM2.5) and household air pollution (defined as the percentage of households using solid cooking fuels and their corresponding exposure to PM2.5). We employed the methods from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 to estimate the attribution of air pollution on type 2 diabetes deaths and disability-adjusted life years (DALYs) by age, sex, year, and province.

Findings

In 2021, about a fifth of the national type 2 diabetes burden was attributable to air pollution, with an age-standardised estimate of 1.76 deaths and 110.79 DALYs per 100,000 population, higher in males. Ambient PM2.5 contributed to 16.89% of deaths and 16.36% of DALYs, while household air pollution contributed to 3.24% of deaths and 3.07% of DALYs. From 1990 to 2021, type 2 diabetes mortality rates due to ambient PM2.5 pollution increased by 264.23%, whereas those from household air pollution decreased by 80.8%. In 2021, Beijing had the highest population attributable fraction (PAFs) of DALYs due to ambient PM2.5 pollution at 19.63%, while Tibet had the highest PAFs for household air pollution at 13.72%. The age-standardised DALYs rates for type 2 diabetes due to ambient PM2.5 varied widely across provinces, from 143.8 per 100,000 people in Tianjin to 21.6 per 100,000 people in Tibet.

Interpretation

Air pollution, especially ambient PM2.5, is a significant risk factor for type 2 diabetes in China. Urgent action is needed to enhance air pollution control and develop locally adapted preventive strategies to reduce the burden of air pollution-related type 2 diabetes.

Funding

Sanming Project of Medicine in Shenzhen (NO. SZSM202111001).

Global trends in deaths and disability-adjusted life years of diabetes attributable to second-hand smoke and the association with smoke-free policies

OBJECTIVES

The diabetic burden attributable to second-hand smoke (SHS) is a global public health challenge. We sought to explore the diabetic burden attributable to SHS by age, sex, and socioeconomic status during 1990-2019 and to evaluate the health benefit of smoke-free policies on this burden.

STUDY DESIGN

Cross-sectional study.

METHODS

The diabetic burden attributable to SHS was extracted from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 dataset. Country-level smoke-free policies were obtained from the World Health Organization Global Health Observatory. The deaths or disability-adjusted life years (DALYs) were quantified, and the average annual percentage changes were calculated. Hierarchical linear mixed models were applied to evaluate the health effects.

RESULTS

From 1990 to 2019, the absolute number of global deaths and DALYs of diabetes attributable to SHS has doubled, and the age-standardised rate has significantly increased. The disease burden was higher in females than in males and increased with increasing age. The SHS-related diabetic burden varied across regions and countries. Age-standardised death or DALY rates first increased and then decreased with increased Socio-demographic Index (SDI), peaking in the 0.60-0.70 range. In low to low-middle, and middle to high-middle SDI countries, SHS-related diabetic deaths and DALYs were significantly lower in countries with more than 3 smoke-free public places than in countries with 0-2 smoke-free public places.

CONCLUSIONS

More attention should be paid to females and the elderly, who bear a heavy SHS-related diabetic burden. Banning smoking in public places was associated with reduced burden of SHS-attributable diabetes, especially in low to middle social development countries.

Association between household fuel combustion and diabetes among middle-aged and older adults in China: A cohort study

BACKGROUND

Few studies examined the associations of household fuel combustion with incident diabetes. The current study emphasizes the association of domestic fuel combustion with diabetes among middle- and older- Chinese.

METHODS

The data was extracted from a national and prospective cohort, the China Health and Retirement Longitudinal Study (CHARLS), which enrolled adults ≥ 45 years. A total of 4610 and 5570 participants were involved in heating and cooking-related analyses. Multivariable logistic models were conducted to assess the association of domestic fuel combustion for heating and cooking with diabetes. Furthermore, we also examined whether it differed from switching fuel types. Subgroup and interaction analyses were performed based on covariates to examine the robustness and find potential effect modifiers.

RESULTS

After about 5-year follow-up, 592 and 716 diabetes were diagnosed in heating and cooking-related analyses. Compared to cleaner fuel users, those who used solid fuel for heating [OR (95 % CI):1.32 (1.05-1.66)] maintained higher risks of incident diabetes. In addition, participants who were exposed to solid fuel for both heating and cooking [OR (95 % CI):1.55 (1.17-2.06)] might have further elevated diabetic risk. Those risks are likely to be attenuated if people switched cooking fuel from solid to cleaner [OR (95 % CI): 0.68 (0.53-0.89)].

CONCLUSIONS

Home solid fuel use for heating is associated with an increased risk of incident diabetes. If solid fuel was concurrently used for both cooking and heating, those risks might be further elevated. Interestingly, as compared to solid fuel users, the participants switching cooking fuel types from solid to cleaner presented reduced diabetic risk.

Associations between Household Solid Fuel Use, Obesity, and Cardiometabolic Health in China: A Cohort Study from 2011 to 2018

This study aims to explore the longitudinal relationship between solid fuel use and CMD incidence based on a nationally representative follow-up cohort study. A total of 6038 participants of the China Health and Retirement Longitudinal Study (CHARLS) were enrolled in the study. CMD is a cluster of diseases that include heart disease, stroke, and type 2 diabetes. Cox proportional-hazards regression models were used to examine the association between solid fuel use and the incidence or multimorbidity of CMD. The interactions between overweight or obesity and household air pollution on CMD incidence were also investigated. In the present study, solid fuel use from cooking or heating, separately or simultaneously, was positively associated with CMD incidence. Elevated solid fuel use was significantly associated with a higher risk of CMD incidence (HR = 1.25, 95% CI: 1.09, 1.43 for cooking; HR = 1.27, 95% CI: 1.11, 1.45 for heating). A statistically significant interaction between household solid fuel and OW/OB on the incidence of CMD and Cardiometabolic multimorbidity was also observed (p < 0.05). Our findings show that household solid fuel is a risk factor for the incidence of CMD. Therefore, reducing household solid fuel use and promoting clean energy may have great public health value for the prevention of CMD.