title: Associations between long-term exposure to ambient particulate air pollution and type 2 diabetes prevalence, blood glucose and glycosylated hemoglobin levels in China.
abstract: The evidence for an association between particulate air pollution and type 2 diabetes mellitus (T2DM) in developing countries was very scarce.
  
  
  
  To investigate the associations of long-term exposure to fine particulate matter (PM2.5) with T2DM prevalence and with fasting glucose and glycosylated hemoglobin (HbA1c) levels in China.
  
  
  
  This is a cross-sectional study based on a nation-wide baseline survey of 11,847 adults who participated in the China Health and Retirement Longitudinal Study from June 2011 to March 2012. The average residential exposure to PM2.5 for each participant in the same period was estimated using a satellite-based spatial statistical model. We determined the association between PM2.5 and T2DM prevalence by multivariable logistic regression models. We also evaluated the association between PM2.5 and fasting glucose and HbA1c levels using multivariable linear regression models. Stratification analyses were conducted to explore potential effect modification.
  
  
  
  We identified 1760 cases of T2DM, corresponding to 14.9% of the study population. The average PM2.5 exposure for all participants was 72.6μg/m(3) during the study period. An interquartile range increase in PM2.5 (41.1μg/m(3)) was significantly associated with increased T2DM prevalence (prevalence ratio, PR=1.14), and elevated levels of fasting glucose (0.26mmol/L) and HbA1c (0.08%). The associations of PM2.5 with T2DM prevalence and with fasting glucose and HbA1c were stronger in several subgroups.
  
  
  
  This nationwide cross-sectional study suggested that long-term exposure to PM2.5 might increase the risk of T2DM in China.
authors.affiliation: School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and Key Lab of Health Technology Assessment of the Ministry of Health, Fudan University, Shanghai, China.
authors.forename: Cong
authors.initials: C
authors.lastname: Liu
authors.affiliation: School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and Key Lab of Health Technology Assessment of the Ministry of Health, Fudan University, Shanghai, China.
authors.forename: Changyuan
authors.initials: C
authors.lastname: Yang
authors.affiliation: National School of Development, Peking University, Beijing, China.
authors.forename: Yaohui
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: State Key Laboratory of Pollution Control and Resource Reuse, School of the Environment, Nanjing University, Nanjing, Jiangsu Province, China.
authors.forename: Zongwei
authors.initials: Z
authors.lastname: Ma
authors.affiliation: State Key Laboratory of Pollution Control and Resource Reuse, School of the Environment, Nanjing University, Nanjing, Jiangsu Province, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Bi
authors.affiliation: Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States.
authors.forename: Yang
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States.
authors.forename: Xia
authors.initials: X
authors.lastname: Meng
authors.affiliation: Institute for Social Science Survey, Peking University, Beijing, China.
authors.forename: Yafeng
authors.initials: Y
authors.lastname: Wang
authors.affiliation: School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and Key Lab of Health Technology Assessment of the Ministry of Health, Fudan University, Shanghai, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Cai
authors.affiliation: School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and Key Lab of Health Technology Assessment of the Ministry of Health, Fudan University, Shanghai, China.|Shanghai Key Laboratory of Atmospheric Particle Pollution and Prevention (LAP), Fudan University, Shanghai, China.
authors.forename: Renjie
authors.initials: R
authors.lastname: Chen
authors.affiliation: School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and Key Lab of Health Technology Assessment of the Ministry of Health, Fudan University, Shanghai, China.|Shanghai Key Laboratory of Atmospheric Particle Pollution and Prevention (LAP), Fudan University, Shanghai, China.
authors.forename: Haidong
authors.initials: H
authors.lastname: Kan
mesh_terms: D000328:Adult; D000368:Aged; D000393:Air Pollutants / Q000032:analysis; D001786:Blood Glucose; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000209:etiology*; D004781:Environmental Exposure / Q000032:analysis; D005260:Female; D006442:Glycated Hemoglobin; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D052638:Particulate Matter / Q000032:analysis / Q000633:toxicity*; D015995:Prevalence
chemical_list: D000393:Air Pollutants; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D052638:Particulate Matter
keywords: Cross-sectional study; Fasting glucose; Fine particulate matter; Glycosylated hemoglobin; Type 2 diabetes mellitus