title: Air pollution and type 1 diabetes in children.
abstract: BACKGROUND
  Over the past decade, there has been a worldwide largely unexplained increase in the incidence of type 1 diabetes in young children. This study explores the quantitative role of exposure to specific air pollutants in the development of type 1 diabetes in children.
  
  
  METHODS
  A total of 402 children were retrospectively studied. Zip code-related, time-specific birth-to-diagnosis exposure to five ambient air pollutants was obtained for 102 children with type 1 diabetes and 300 healthy children receiving care at a single hospital. Pollution exposure levels were created by summing up zip code-specific pollution data and dividing by months of exposure from birth to diagnosis. Analysis employed chi2, two-tailed independent sample t-test and unconditional logistic regression.
  
  
  RESULTS
  Odds ratio (OR) was significantly high for cumulative exposure to ambient ozone (O3) and sulfate (SO4) in cases compared with controls, OR = 2.89 [95% confidence interval (CI) = 1.80-4.62] and OR = 1.65 (CI = 1.20-2.28), respectively, even after adjustment for several potential confounders. Passive smoking was more frequent in children with diabetes (30 vs. 10%, p = 0.001). Attending day care and breast feeding in infancy were less frequent in children with diabetes (14 vs. 23%, p = 0.025; 59 vs. 78%, p = 0.001). Family history of diabetes, autoimmune disease and drug abuse was more frequent in cases (p < 0.01).
  
  
  CONCLUSIONS
  Cumulative exposure to ozone and sulfate in ambient air may predispose to the development of type 1 diabetes in children. Early infant formula feeding and passive smoking in the household may precipitate or accelerate the onset of type 1 diabetes.
authors.affiliation: Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda, CA, USA. ehathout@ahs.llumc.edu
authors.forename: Eba H
authors.initials: EH
authors.lastname: Hathout
authors.forename: W Lawrence
authors.initials: WL
authors.lastname: Beeson
authors.forename: Mariam
authors.initials: M
authors.lastname: Ischander
authors.forename: Ravindra
authors.initials: R
authors.lastname: Rao
authors.forename: John W
authors.initials: JW
authors.lastname: Mace
mesh_terms: D000293:Adolescent; D000397:Air Pollution / Q000009:adverse effects*; D001724:Birth Weight; D002140:California / Q000453:epidemiology; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology* / Q000209:etiology; D004522:Educational Status; D004781:Environmental Exposure / Q000009:adverse effects*; D005006:Ethnicity; D005190:Family; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D010126:Ozone / Q000032:analysis; D012016:Reference Values; D019966:Substance-Related Disorders / Q000453:epidemiology; D013431:Sulfates / Q000032:analysis; D014028:Tobacco Smoke Pollution
chemical_list: D013431:Sulfates; D014028:Tobacco Smoke Pollution; D010126:Ozone