Risk Analysis Of The Incidence Of Elderly Diabetes In Northern China Influenced By Air Pollution And Meteorological Factors

Objective: According to the annual Globle Burdern of Disease(GDB)assessment,the burden of disease caused by diabetes is increasing year by year.What’s more,the impact of air pollution on health cannot be ignored,especially in China.At present,more and more researches have shown that air pollution is associated with the risk of diabetes.Our study was aimed to explore possible associations between air pollution and the incidence of diabetes in the elder(≥60 years old)in Binhai New District,so that we can provide scientific evidence and reference for the formulate of public health policy and environmental governance norms and then relieve the burden of disease caused by diabetes.To make the relationship between meteorological factors and diabetes incidence three-dimensional,we explored the lag and non-linear effects of meteorological factors.Besides,we also observed the interaction of different air pollutants and meteorological factors.Method: The study involved 37 communities of Binhai New District and contained around 19 thousand people without diabetes who were ≥60 years old to observe the incidence of diabetes.First,we studied the correlations between air pollutants and meteorological factors through Spearman correlation analysis.Then we used the GAM to explore the relationship between incident diabetes and air pollutants,meteorological factors and constructed a DLNM to estimate the lag and non-linear effects.In the model combined GAM and DLNM,we first observed the situation of each factor separated,and then selected statistically significant factors according to the results of single factor model to incorporate in the final multi-factor model.Result: 1.During 2014-2017,there was a total of 7585 new-onset diabetes patients among the 190,453 non-diabetic participants aged ≥60 years old,and the average annual incidence of diabetes was 9.9 ‰.The analysis of biochemical indicators in these patients found that the average cholesterol level among males was lower than that among females,while the average fasting blood glucose was opposite.And in overweight or obese people,fasting blood glucose,triglyceride and liver enzymes were higher than others.Besides,analysis of lifestyles found that people ≥75 years old or females tended to be more inactive,and male smokers far exceeded female.2.There was a positive correlation between each two pollutants in PM2.5,PM10,NO2,SO2 and CO,and they were all negatively correlated with O3.Except for O3,other air pollutants were negatively correlated with sunshine.3.In single-pollutant model,exposured to PM2.5,PM10,NO2,and CO were positively correlated with diabetes incidence.In the multi-pollutant model,the relationships between PM2.5,PM10 and incident diabetes were stable.However,there was no statistical correlation between either O3 or SO2 and diabetes incidence.4.The relationship between meteorological factors and diabetes was non-linear.Increased temperature,excessive humidity or dryness,shortened sunshine duration and precipitation(18-47mm)were positively correlated with the incidence of diabetes.5.Finally,we took PM2.5,NO2,and CO into the final multi-factor model and adjusted with temperature,humidity,and sunshine as covariates.The result showed the RR of diabetes was 1.092(95%CI:1.021-1.168)per 10ug/m3 increase in PM2.5.While,there were no statistical correlation between NO2,CO and diabetes incidence.6.Compared to males,females were more susceptible to PM2.5 and the RR of diabetes was 1.163(95% CI: 1.032-1.311)among females per 10ug/m3 increase in PM2.5.And PM2.5 was more strongly associated with diabetes in the population aged ≥ 75 years old(RR: 1.140;95%CI: 1.032-1.259)and in obese subjects(RR:1.135;95% CI: 1.007-1.279).Conclusion: During 2014-2017,the average annual incidence of diabetes was 9.9‰,among the 190,453 residents aged ≥60 years old who regularly participated in the physical examination in Tianjin Binhai New District.PM2.5 exposure was associated with an increased incidence of diabetes.In this population aged ≥ 60 years old,exposured to PM2.5 was related to diabetes incidence,especially among females,people aged ≥75 and obese subjects.Temperature among-3 ℃-15℃,humidity under 25% or above 81% and the duration of sunshine less tnan 13.6h all increased the risk of diabetes.The results of this study have guiding significance for the formulation of public health policy and environmental governance,and even conducive to providing clinical intervention to benefit human health.