Long-Term Fine Particulate Matter Exposure and Mortality From Diabetes in Canada

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. RESEARCH DESIGN AND METHODS: We evaluated the association between long-term exposure to ambient fine particulate matter (PM(2.5)) 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 PM(2.5) were derived from satellite observations. The hazard ratios (HRs) for diabetes-related mortality were related to PM(2.5) and adjusted for individual-level and contextual variables using Cox proportional hazards survival models. RESULTS: Mean PM(2.5) exposure levels for the entire population were low (8.7 µg/m(3); SD, 3.9 µg/m(3); interquartile range, 6.2 µg/m(3)). In fully adjusted models, a 10-µg/m(3) elevation in PM(2.5) 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 PM(2.5) concentration <5 µg/m(3). CONCLUSIONS: Long-term exposure to PM(2.5), 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.