title: Occupational metal exposures, smoking and risk of diabetes and prediabetes.
abstract: Metal exposure and tobacco smoking have been independently associated with diabetes, but no study has been conducted to investigate the interaction between them on the risk of diabetes.
  
  
  
  To investigate the effect of occupational exposure to metals, and potential effect modification by smoking, on the risk of diabetes and prediabetes in a cohort of Chinese male workers.
  
  
  
  We assessed metal exposure and tobacco smoking at baseline in the Jinchang Cohort of male workers. We used Poisson regression analyses to estimate the interaction between smoking and metal exposures based on occupations, which we grouped according to the measured urinary metal levels.
  
  
  
  Among the 26008 study subjects, compared with non-smokers, the adjusted prevalence ratio (PR) for diabetes was 1.8 [95% confidence interval (CI) 1.3-2.4] for smokers of >40 pack-years. The adjusted PRs were 1.2 (95% CI 1.1-1.4) among mining/production workers and 2.7 (95% CI 2.4-3.0) among smelting/refining workers, both compared with office workers. There was significant effect modification under the additive model between smoking and metal exposure on the prevalence of diabetes (Pinteraction= 0.001), with an adjusted PR of 3.6 (95% CI 2.4-5.4) for those with >40 pack-years of smoking who had the highest metal exposures, whereas no significant interaction was observed for prediabetes.
  
  
  
  Both exposure to metals and heavy smoking were associated with an increased prevalence of diabetes in this large cohort of male workers. There was also strong interaction between these two exposures in affecting diabetes risk that should be confirmed in future studies.
authors.affiliation: Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, South Donggang Xi Road 199, Lanzhou 730000, Gansu, P.R. China, Department of Epidemiology, School of Public Health, Brown University, 121 South Main Street, Providence, RI 02912, USA.
authors.forename: A
authors.initials: A
authors.lastname: Yang
authors.affiliation: Center of Medical Laboratory, Lanzhou University, Lanzhou 730000, Gansu, P.R. China.
authors.forename: N
authors.initials: N
authors.lastname: Cheng
authors.affiliation: Workers' Hospital, Jinchuan Group Co., Ltd., Jinchang 737140, Gansu, P.R. China.
authors.forename: H
authors.initials: H
authors.lastname: Pu
authors.affiliation: Department of Epidemiology, School of Public Health, Brown University, 121 South Main Street, Providence, RI 02912, USA.
authors.forename: S
authors.initials: S
authors.lastname: Liu
authors.affiliation: Cancer Hospital, Chinese Academy of Medical Sciences, Beijing 100021, P.R. China.
authors.forename: M
authors.initials: M
authors.lastname: Dai
authors.affiliation: Department of Epidemiology, School of Public Health, Brown University, 121 South Main Street, Providence, RI 02912, USA.
authors.forename: T
authors.initials: T
authors.lastname: Zheng
authors.affiliation: Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, South Donggang Xi Road 199, Lanzhou 730000, Gansu, P.R. China, baiyana@lzu.edu.cn tongzhang_zheng@brown.edu.
authors.forename: Y
authors.initials: Y
authors.lastname: Bai
keywords: Association; diabetes mellitus; metals; occupational exposure; prediabetes; smoking.