title: Long-term exposure to fine particulate matter and incidence of diabetes in the Danish Nurse Cohort.
abstract: OBJECTIVE
  It has been suggested that air pollution may increase the risk of type 2 diabetes but data on particulate matter with diameter <2.5μm (PM2.5) are inconsistent. We examined the association between long-term exposure to PM2.5 and diabetes incidence.
  
  
  METHODS
  We used the Danish Nurse Cohort with 28,731 female nurses who at recruitment in 1993 or 1999 reported information on diabetes prevalence and risk factors, and obtained data on incidence of diabetes from National Diabetes Register until 2013. We estimated annual mean concentrations of PM2.5, particulate matter with diameter <10μm (PM10), nitrogen oxides (NOx) and nitrogen dioxide (NO2) at their residence since 1990 using a dispersion model and examined the association between the 5-year running mean of pollutants and diabetes incidence using a time-varying Cox regression.
  
  
  RESULTS
  Of 24,174 nurses 1137 (4.7%) developed diabetes. We detected a significant positive association between PM2.5 and diabetes incidence (hazard ratio; 95% confidence interval: 1.11; 1.02-1.22 per interquartile range of 3.1μg/m(3)), and weaker associations for PM10 (1.06; 0.98-1.14 per 2.8μg/m(3)), NO2 (1.05; 0.99-1.12 per 7.5μg/m(3)), and NOx (1.01; 0.98-1.05 per 10.2μg/m(3)) in fully adjusted models. Associations with PM2.5 persisted in two-pollutant models. Associations with PM2.5 were significantly enhanced in never smokers (1.24; 1.09-1.42), and augmented in obese (1.25; 1.06-1.47) and subjects with myocardial infarction (1.32; 0.86-2.02), but without significant interaction.
  
  
  CONCLUSIONS
  Fine particulate matter may the most relevant pollutant for diabetes development among women, and non-smokers, obese women, and heart disease patients may be most susceptible.
authors.affiliation: Center for Epidemiology and Screening, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Anne Busch
authors.initials: AB
authors.lastname: Hansen
authors.affiliation: Danish Cancer Research Center, Danish Cancer Society, Copenhagen, Denmark.
authors.forename: Line
authors.initials: L
authors.lastname: Ravnskjær
authors.affiliation: Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Steffen
authors.initials: S
authors.lastname: Loft
authors.affiliation: Danish Cancer Research Center, Danish Cancer Society, Copenhagen, Denmark.
authors.forename: Klaus Kaae
authors.initials: KK
authors.lastname: Andersen
authors.affiliation: Research Center for Prevention and Health, Capitol Region of Denmark, Rigshospitalet - Glostrup, University of Copenhagen, Glostrup, Denmark; Department of Occupational and Environmental Medicine, Bispebjerg - Frederiksberg Hospital, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Elvira Vaclavik
authors.initials: EV
authors.lastname: Bräuner
authors.affiliation: National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
authors.forename: Rikke
authors.initials: R
authors.lastname: Baastrup
authors.affiliation: Center for Epidemiology and Screening, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Claire
authors.initials: C
authors.lastname: Yao
authors.affiliation: Department of Environmental Science, Aarhus University, Roskilde, Denmark.
authors.forename: Matthias
authors.initials: M
authors.lastname: Ketzel
authors.affiliation: Department of Environmental Science, Aarhus University, Roskilde, Denmark.
authors.forename: Thomas
authors.initials: T
authors.lastname: Becker
authors.affiliation: Department of Environmental Science, Aarhus University, Roskilde, Denmark.
authors.forename: Jørgen
authors.initials: J
authors.lastname: Brandt
authors.affiliation: Department of Environmental Science, Aarhus University, Roskilde, Denmark.
authors.forename: Ole
authors.initials: O
authors.lastname: Hertel
authors.affiliation: Center for Epidemiology and Screening, Department of Public Health, University of Copenhagen, Copenhagen, Denmark. Electronic address: zorana.andersen@sund.ku.dk.
authors.forename: Zorana Jovanovic
authors.initials: ZJ
authors.lastname: Andersen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000393:Air Pollutants / Q000009:adverse effects / Q000032:analysis*; D000397:Air Pollution / Q000032:analysis; D003718:Denmark / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D004781:Environmental Exposure / Q000009:adverse effects / Q000032:analysis*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009585:Nitrogen Dioxide / Q000032:analysis; D009589:Nitrogen Oxides / Q000032:analysis; D052638:Particulate Matter / Q000009:adverse effects / Q000032:analysis*; D016016:Proportional Hazards Models; D012307:Risk Factors
chemical_list: D000393:Air Pollutants; D009589:Nitrogen Oxides; D052638:Particulate Matter; D009585:Nitrogen Dioxide
keywords: Air pollution; Diabetes; Fine particles; PM(2.5)