title: Inverse association between diabetes and altitude: a cross-sectional study in the adult population of the United States.
abstract: OBJECTIVE
  To determine whether geographical elevation is inversely associated with diabetes, while adjusting for multiple risk factors.
  
  
  METHODS
  This is a cross-sectional analysis of publicly available online data from the Behavioral Risk Factor Surveillance System, 2009. Final dataset included 285,196 US adult subjects. Odds ratios were obtained from multilevel mixed-effects logistic regression analysis.
  
  
  RESULTS
  Among US adults (≥20 years old), the odds ratio for diabetes was 1.00 between 0 and 499 m of altitude (reference), 0.95 (95% confidence interval, 0.90-1.01) between 500 and 1,499 m, and 0.88 (0.81-0.96) between 1,500 and 3,500 m, adjusting for age, sex, body mass index, ethnicity, self-reported fruit and vegetable consumption, self-reported physical activity, current smoking status, level of education, income, health status, employment status, and county-level information on migration rate, urbanization, and latitude. The inverse association between altitude and diabetes in the US was found among men [0.84 (0.76-0.94)], but not women [1.09 (0.97-1.22)].
  
  
  CONCLUSIONS
  Among US adults, living at high altitude (1,500-3,500 m) is associated with lower odds of having diabetes than living between 0 and 499 m, while adjusting for multiple risk factors. Our findings suggest that geographical elevation may be an important factor linked to diabetes.
authors.affiliation: Diabetes and Obesity Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
authors.forename: Orison O
authors.initials: OO
authors.lastname: Woolcott
authors.forename: Oscar A
authors.initials: OA
authors.lastname: Castillo
authors.forename: Cesar
authors.initials: C
authors.lastname: Gutierrez
authors.forename: Robert M
authors.initials: RM
authors.lastname: Elashoff
authors.forename: Darko
authors.initials: D
authors.lastname: Stefanovski
authors.forename: Richard N
authors.initials: RN
authors.lastname: Bergman
mesh_terms: D000328:Adult; D000531:Altitude; D040343:Behavioral Risk Factor Surveillance System; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D012307:Risk Factors; D014481:United States / Q000453:epidemiology