title: Long-term fine particulate matter exposure and mortality from diabetes in Canada.
abstract: OBJECTIVE
  Recent studies suggest that chronic exposure to air pollution can promote the development of diabetes. However, whether this relationship actually translates into an increased risk of mortality attributable to diabetes is uncertain.
  
  
  METHODS
  We evaluated the association between long-term exposure to ambient fine particulate matter (PM2.5) and diabetes-related mortality in a prospective cohort analysis of 2.1 million adults from the 1991 Canadian census mortality follow-up study. Mortality information, including ∼5,200 deaths coded as diabetes being the underlying cause, was ascertained by linkage to the Canadian Mortality Database from 1991 to 2001. Subject-level estimates of long-term exposure to PM2.5 were derived from satellite observations. The hazard ratios (HRs) for diabetes-related mortality were related to PM2.5 and adjusted for individual-level and contextual variables using Cox proportional hazards survival models.
  
  
  RESULTS
  Mean PM2.5 exposure levels for the entire population were low (8.7 µg/m3; SD, 3.9 µg/m3; interquartile range, 6.2 µg/m3). In fully adjusted models, a 10-µg/m3 elevation in PM2.5 exposure was associated with an increase in risk for diabetes-related mortality (HR, 1.49; 95% CI, 1.37-1.62). The monotonic change in risk to the population persisted to PM2.5 concentration<5 µg/m3.
  
  
  CONCLUSIONS
  Long-term exposure to PM2.5, even at low levels, is related to an increased risk of mortality attributable to diabetes. These findings have considerable public health importance given the billions of people exposed to air pollution and the worldwide growing epidemic of diabetes.
authors.affiliation: Corresponding author: Robert D. Brook, robdbrok@umich.edu.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Brook
authors.forename: Sabit
authors.initials: S
authors.lastname: Cakmak
authors.forename: Michelle C
authors.initials: MC
authors.lastname: Turner
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Brook
authors.forename: Dan L
authors.initials: DL
authors.lastname: Crouse
authors.forename: Paul A
authors.initials: PA
authors.lastname: Peters
authors.forename: Aaron
authors.initials: A
authors.lastname: van Donkelaar
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Villeneuve
authors.forename: Orly
authors.initials: O
authors.lastname: Brion
authors.forename: Michael
authors.initials: M
authors.lastname: Jerrett
authors.forename: Randall V
authors.initials: RV
authors.lastname: Martin
authors.forename: Sanjay
authors.initials: S
authors.lastname: Rajagopalan
authors.forename: Mark S
authors.initials: MS
authors.lastname: Goldberg
authors.forename: C Arden
authors.initials: CA
authors.lastname: Pope
authors.forename: Richard T
authors.initials: RT
authors.lastname: Burnett
mesh_terms: D000328:Adult; D000368:Aged; D000393:Air Pollutants / Q000633:toxicity; D002170:Canada; D003920:Diabetes Mellitus / Q000401:mortality*; D004781:Environmental Exposure / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D052638:Particulate Matter / Q000633:toxicity*; D016016:Proportional Hazards Models; D011446:Prospective Studies
chemical_list: D000393:Air Pollutants; D052638:Particulate Matter