title: Risk of incident diabetes in relation to long-term exposure to fine particulate matter in Ontario, Canada.
abstract: BACKGROUND
  Laboratory studies suggest that fine particulate matter (≤ 2.5 µm in diameter; PM(2.5)) can activate pathophysiological responses that may induce insulin resistance and type 2 diabetes. However, epidemiological evidence relating PM2.5 and diabetes is sparse, particularly for incident diabetes.
  
  
  OBJECTIVE
  We conducted a population-based cohort study to determine whether long-term exposure to ambient PM(2.5) is associated with incident diabetes.
  
  
  METHODS
  We assembled a cohort of 62,012 nondiabetic adults who lived in Ontario, Canada, and completed one of five population-based health surveys between 1996 and 2005. Follow-up extended until 31 December 2010. Incident diabetes diagnosed between 1996 and 2010 was ascertained using the Ontario Diabetes Database, a validated registry of persons diagnosed with diabetes (sensitivity = 86%, specificity = 97%). Six-year average concentrations of PM2.5 at the postal codes of baseline residences were derived from satellite observations. We used Cox proportional hazards models to estimate the associations, adjusting for various individual-level risk factors and contextual covariates such as smoking, body mass index, physical activity, and neighborhood-level household income. We also conducted multiple sensitivity analyses. In addition, we examined effect modification for selected comorbidities and sociodemographic characteristics.
  
  
  RESULTS
  There were 6,310 incident cases of diabetes over 484,644 total person-years of follow-up. The adjusted hazard ratio for a 10-µg/m(3) increase in PM(2.5) was 1.11 (95% CI: 1.02, 1.21). Estimated associations were comparable among all sensitivity analyses. We did not find strong evidence of effect modification by comorbidities or sociodemographic covariates.
  
  
  CONCLUSIONS
  This study suggests that long-term exposure to PM2.5 may contribute to the development of diabetes.
authors: Public Health Ontario, Toronto, Ontario, Canada.
authors: Hong
authors: H
authors: Chen
authors: Richard T
authors: RT
authors: Burnett
authors: Jeffrey C
authors: JC
authors: Kwong
authors: Paul J
authors: PJ
authors: Villeneuve
authors: Mark S
authors: MS
authors: Goldberg
authors: Robert D
authors: RD
authors: Brook
authors: Aaron
authors: A
authors: van Donkelaar
authors: Michael
authors: M
authors: Jerrett
authors: Randall V
authors: RV
authors: Martin
authors: Jeffrey R
authors: JR
authors: Brook
authors: Ray
authors: R
authors: Copes
mesh_terms: D000328:Adult; D000368:Aged; D000393:Air Pollutants / Q000032:analysis / Q000633:toxicity*; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000139:chemically induced* / Q000453:epidemiology; D004781:Environmental Exposure; D004784:Environmental Monitoring; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D010316:Particle Size; D052638:Particulate Matter / Q000032:analysis / Q000633:toxicity*; D058998:Remote Sensing Technology; D012307:Risk Factors
chemical_list: D000393:Air Pollutants; D052638:Particulate Matter
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