The Effect Of Fine Particulate Matter On Hospital Admission For Type 2 Diabetic Patients:A Case-crossover Study In Tang Shan

Objective A number of epidemiological and animal experimental studies have found that fine particulate matter(PM_2.5)may increase morbidity and mortality of type 2 diabetes mellitus.It is suggested that PM_2.5 may be an important risk factor for inducing and aggravating type 2 diabetes mellitus,some studies haven't found the association between them.In order to further explore whether PM_2.5 is the cause of type 2 diabetes mellitus and provide epidemiological reliable evidence for revealing the etiology of type 2diabetes mellitus,we conducted time-stratified case-crossover study to explore effect PM_2.5 on the number of hospitalized patients with type 2 diabetes mellitus in Tangshan city.Methods Data of type 2 diabetes mellitus were collected from the Endocrinology Department of the class A hospitals of grade III from 1 January 2015 to 31 December2017 in Tangshan city,including name,sex,age,date of admission,preliminary diagnosis and residence address.Meanwhile,data of PM_2.5,PM₁₀?Inhalable particle?and SO₂,NO₂ and O₃-8h were collected from the website of China Environmental Monitoring Station.The daily average temperature?T?and relative humidity?RH?were collected from the website of Hebei Meteorological Bureau during the same period.Spearman was used to analyze the correlation between atmospheric pollutants and meteorological factors.Single pollution model was used to analyze the hysteresis effect of atmospheric pollutants on hospitalization of type 2 diabetes mellitus,and determine the optimal hysteresis period of atmospheric pollutants according to the principle of odds ratio?OR?.The optimal lag period of each pollutant was incorporated into the double pollutant model and the multi-pollutant model to analyze the impact of air pollutants and PM_2.5 on hospitalization of type 2 diabetes mellitus,and then the influence of gender and age on PM_2.5 and hospitalization of type 2 diabetes mellitus is analyzed.SPSS 17.0 and R3.5.1versions were used in statistical analysis,with statistical significance of P<0.05 on both sides.Results Correlation analysis between atmospheric pollutants and meteorological factors showed that PM_2.5,PM₁₀,NO₂ and SO₂ were negatively correlated with temperature,O₃was positively correlated with temperature.PM_2.5,PM₁₀,NO₂ and SO₂ were positively correlated with relative humidity,O₃ was negatively correlated with relative humidity.PM_2.5,PM₁₀,NO₂ and SO₂ were positively correlated,but negatively correlated with O₃.In single pollutant model,after adjusting for potential confounders,the odds ratio?OR?for every 10?g/m³ increase of PM_2.5 concentration?Lag3?was 1.013?95%CI:1.004-1.022?for hospitalized patients with type 2 diabetes,that is,the number of hospitalized patients with type 2 diabetes increased by 1.3%.After adjusting for PM₁₀,NO₂,SO₂ and O₃,OR for every 10?g/m³ increase of PM_2.5 concentration were 1.003?95%CI:0.982-1.024?,1.014?95%CI:1.001-1.028?,1.013?95%CI:1.004-1.022?,1.012?95%CI:1.003-1.021?respectively.Adjusting for NO₂,SO₂,O₃ simultaneously,OR was 1.014?95%CI:1.001-1.028??P<0.05?.After simultaneously controlling NO₂ and SO₂,NO₂ and O₃,SO₂ and O₃,the OR values were 1.014?95%CI:1.001-1.028?,1.014?95%CI:1.001-1.028?,1.013?1.004-1.022??P<0.05?respectively.After adjusting gender and age respectively,OR for every 10?g/m³ increase of PM_2.5 concentration?Lag6?OR value was 1.015?95%CI:1.003-1.027??P<0.05?for female hospitalized patients with type 2diabetes.After adjusting for PM₁₀,NO₂,SO₂ and O₃,respectively,OR values were 1.014?95%CI:1.002-1.026?,1.014?95%CI:1.002-1.027?,1.014?95%CI:1.001-1.027?and1.015?95%CI:1.003-1.028?.After simultaneously controlling PM₁₀,NO₂,O₃,OR was1.014?95%CI:1.002-1.026??P<0.05?.After adjusting for PM₁₀ and NO₂ simultaneously,OR was 1.014?95%CI:1.002-1.026??P<0.05?.Similarly,after adjusting for PM₁₀0 and O₃,NO₂ and O₃,SO₂ and O₃,OR were 1.014?95%CI:1.001-1.026?,1.014?95%CI:1.002-1.027?,1.015?95%CI:1.003-1.027?,P values were less than 0.05.OR for every10?g/m³ increase of PM_2.5 concentration?Lag7?was 1.019?95%CI:1.010-1.027?for hospitalized elderly??60 years old?patients with type 2 diabetes.OR was 1.022?95%CI:1.013-1.031??P<0.05?after adjusted for PM₁₀.There was no effect on hospitalization of male and non-elderly?<60 years old?patients with type 2 diabetes mellitus.Conclusion The PM_2.5 concentration is related to the hospitalization of type 2 diabetes mellitus from 2015 to 2017 in Tangshan,and there is a lagging effect.The number of hospitalized patients with type 2 diabetes mellitus will increase by the increase of PM_2.5concentration,and the female and elderly population will be more sensitive.Figure25;Table18;Reference 101...