Study On The Spatial Distribution Of Diabetes And Its Relationship With PM2.5 In Middle-aged And Elderly People In China Based On CHARLS

BackgroundMany studies have linked air pollution to the development of diabetes.Around one in seven new cases of diabetes worldwide in 2016 were caused by air pollution,and even mild air pollution can increase the risk of diabetes.The burden of diabetes caused by air pollution is particularly severe in developing countries and less developed regions.Currently.China has become the country with the highest PM2.5 attributable disease burden in the world.Studies in the United States.Italy.Chile and other countries have shown that air pollution increases the risk of diabetes to a certain extent.However,there is still a lack of empirical analysis on the relationship between air pollution and diabetes in ChinaObjectiveBased on the perspective of spatial econometrics,firstly,geographic information system(GIS)technology was used to visually analyze the spatial distribution of diabetes and pre-diabetes prevalence in the elderly aged 45 and above in China.Then,the spatial heterogeneity of the main influencing factors of diabetes was further understood and the relationship between PM2.5 and diabetes was clarified,providing scientific basis for improving regional diabetes prevention and air pollution control measuresMethodsThis study applied the data of 2015 China Health and Retirement Longitudinal Survey(CHARLS),covering a total of 12,896 sample population.The data included information on the socio-demographic characteristics,behavioral lifestyle and health-related information of the aged over 45 in 28 provinces and autonomous regions of the Chinese mainland(except Hong Kong,Macao,Taiwan,Hainan,Ningxia and Tibet).The average annual PM2.5 concentration in each province and autonomous region in 2015 was derived from the Atmospheric Composition Analysis Group of the United States.Spearman rank correlation Analysis and logistic regression Analysis were used to quantify the relationship between PM2.5 and diabetes and further explore the differences among different characteristic populations.Arc Map was used to visualize the prevalence of diabetes and pre-diabetes,and the spatial heterogeneity of the main influencing factors of diabetes was analyzed by using the geographical weighted regression model.The preliminary data collation and database construction were carried out by Stata14.2,the spatial statistical analysis was implemented by Geoda1.2.0 and Arc GIS 10.2,and the correlation and regression analysis were performed by SPSS24.0.ResultsIn 2015,the prevalence rates of diabetes and pre-diabetes were 15.4%(6.7%?29.6%)and 53.6%(42.3%?66.4%)in China(except Hong Kong,Macao,Taiwan,Hainan,Ningxia and Tibet)among Chinese aged 45 and above.The results of spatial statistics showed that there was a weak positive spatial autocorrelation in the prevalence of diabetes(Moran 'I=0.160).Local-spatial autocorrelation analysis showed that diabetes was mainly concentrated in north China.PM2.5 was positively correlated with the prevalence of diabetes(rs=0.486),Logistic regression results showed that PM2.5 exposure had a higher risk for women(OR=1.047),people aged 60 and above(OR=1.053),people in rural areas(OR=1.027),people with low educational background(OR=1.046),people who had never smoked(OR=1.060),people who had never drunk alcohol(OR=1.051)and people with normal BMI(OR=1.087).The results of geographical weighted regression showed that the main factors affecting the prevalence of diabetes in each province were urban population ratio,proportion of people who drink alcohol,obesity rate,high cholesterol rate and PM2.5 concentration,which presenting spatial distribution heterogeneity.From the perspective of spatial geography,the positive spatial correlation effect of PM2.5 pollution is significant(Moran 'i=0.350).And there are significant spatial differences in the impact of PM2.5 pollution on the prevalence of diabetes,with the eastern coastal areas having the largest impact,followed by the central region,and the western regions having the least negative effectConclusionIn China,the prevalence of pre-diabetes in the aged 45 years and above is relatively high,which is worthy of vigilance.There is spatial heterogeneity in the distribution of main influencing factors of diabetes.In addition,there is a certain relationship between diabetes and air pollution,and the influence of PM2.5 pollution on diabetes is different in different regions and people with different characteristics,the mechanism of which needs further study.