Aug 2026· PLoS ONE· Vol 21, pp. e0354711· 0 citations· 23 references
Medicine
TL;DR
Long-term exposure to air pollutants, particularly NO2 and PM10, is associated with an increased risk of microvascular complications among individuals with diabetes, and the observed risk appears to be persistent and may begin at relatively low exposure levels, underscoring the need for preventive strategies targeting environmental risk factors.
Abstract
Objective To investigate the association between long-term exposure to air pollution and the risk of microvascular complications in individuals with diabetes, and provide the evidence to inform environmental strategies for prevention. Methods The data were collected from UK Biobank cohort (n = 9,671). Kaplan-Meier curves and log-rank tests were used to compare cumulative incidence across exposure groups. Cox proportional hazards models were employed to evaluate the associations between air pollutant exposure and the development of microvascular complications, with adjusting for demographic, clinical, and biochemical covariates. Stratified and sensitivity analyses were conducted to assess the robustness of the findings. Additionally, restricted cubic splines were used to explore potential nonlinear relationships between pollutant concentrations and complication risk. Results With a median follow-up time of 12.4 years, 2,104 participants (21.8%) developed microvascular complications. The Kaplan-Meier analysis demonstrated early divergence in cumulative incidence curves, suggesting an early impact of air pollution exposure on vascular outcomes. After multivariable adjustment, higher levels of air pollution exposure were significantly associated with increased risk of microvascular complications in patients with diabetes. Compared to the lowest quartile, participants in the highest quartile of exposure had elevated risks (NO2: HR = 1.27, 95% CI: 1.12–1.45; PM10: HR = 1.44, 95% CI: 1.27–1.64). These associations remained consistent across stratified and sensitivity analyses. Conclusion Long-term exposure to air pollutants, particularly NO2 and PM10, is associated with an increased risk of microvascular complications among individuals with diabetes. The observed risk appears to be persistent and may begin at relatively low exposure levels, underscoring the need for preventive strategies targeting environmental risk factors.
Global urbanization and increasing energy consumption have caused widespread PM₂.₅ pollution. Accumulating evidence indicates long-term PM₂.₅ exposure correlates with elevated type 2 diabetes mellitus (T2DM) risk. This study was conducted based on prospective cohort designs, with a systematic literature search performed in PubMed, EMBASE, Web of Science, and other major academic databases. By integrating high-quality published evidence and rigorously minimizing biases from residual confounding, reverse causality, and exposure measurement error, this study systematically evaluates the causal effect of PM₂.₅ exposure on T2DM. The results confirmed a significant causal relationship between long-term PM₂.₅ exposure and elevated prevalence and mortality of T2DM. Populations susceptible to diabetes are recommended to take targeted measures to reduce air pollution exposure. This study carries important theoretical and practical implications for the integrated prevention and control of chronic diseases, and provides robust scientific evidence for developing public health strategies to mitigate air pollution-related health risks and reduce the incidence of T2DM.
Jianming Jiao· Theoretical and Natural Scie...· 0 citations
BACKGROUND
Air pollution is associated with anemia in children, however, longitudinal data supporting this association are insufficient.
METHODS
From 2019 to 2023, we conducted a dynamic cohort study involving 33,900 participants from 119 primary and secondary schools across 16 districts in Shanghai. We obtained the daily average concentrations of five air pollutants (PM2.5, O₃, NO₂, SO₂, and CO) based on school addresses using the China High Air Pollutants (CHAP) dataset to assess the exposure levels of the study subjects. We used latent class mixed models to determine the longitudinal trajectories of hemoglobin (Hb) and multinomial logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals (CIs) between trajectory categories. Linear and logistic regression models were used to evaluate the associations between air pollutant exposure level and Hb and anemia risk, respectively, and Cox regression models was used for longitudinal validation. Interaction terms for gender, age, and body mass index (BMI) were used to explore the modifying effects of these factors.
RESULTS
At the baseline survey, 3,213 students (9.48%) were identified as anemic, with a higher proportion of girls (63.8%). During an average follow-up period of 3.16 years, 1,685 participants (4.9%) were observed to develop anemia. Children's hemoglobin levels showed three different trajectory patterns throughout the study period. Exposure to PM2.5 [OR (95% CI) = 2.124(1.853, 2.433)] was associated with adverse trajectory changes characterized by "low hemoglobin". Longitudinal analysis shows that exposure to PM2.5 [HR = 1.213, 95% CI: (1.068, 1.376)], NO2 [HR = 1.409, 95% CI: (1.254, 1.584)], and SO2 [HR = 1.268, 95% CI: (1.172, 1.372)] is associated with an increased risk of anemia. Stratified analysis showed that the adverse effects of PM2.5 exposure on anemia were more pronounced in younger or underweight children. The adverse effects of NO2 exposure on anemia were more significant in older or obese children. The association between SO2 exposure and the impact on anemia mainly appeared in male or younger children.
CONCLUSIONS
Long-term exposure to air pollutants is associated with an increased burden of anemia in children and adolescents, and attention should be focused on vulnerable groups such as girls and underweight children.
K. Zheng, Fengyun Zhang, L. Chu et al.· BMC Public Health· 0 citations
The relationship between chronic cadmium (Cd) exposure and diabetes risk remains uncertain, as previous epidemiological studies have reported inconsistent results. This study aimed to investigate the association between urinary Cd (U-Cd) levels and new-onset diabetes in a large longitudinal Asian cohort. Using data from the Chang Gung Research Database in Taiwan, we included 9576 non-diabetic adults aged 18-65 years who had baseline U-Cd measurements between 2013 and 2020. Participants were stratified into quartiles based on U-Cd concentrations. The primary outcome was new-onset diabetes, assessed using Cox proportional hazards models adjusted for demographic characteristics, body mass index, smoking status, comorbidities, laboratory parameters, and diabetes-related medication use. During a median follow-up of 5.1 years, 585 participants developed diabetes. The crude incidence rates per 1000 person-years across increasing U-Cd quartiles were 9.16, 11.76, 14.97, and 13.10, showing no significant linear trend (P = 0.206). Fully adjusted hazard ratios for quartiles 2, 3, and 4 compared with quartile 1 were 0.85 (95% confidence interval: 0.65-1.11), 1.02 (0.78-1.33), and 0.80 (0.60-1.07), respectively. Restricted cubic spline analyses revealed no significant dose-response relationship across the observed U-Cd range (P = 0.639). These findings were consistent across subgroups defined by sex, age, smoking status, and individuals at high risk for developing diabetes (all P for interaction > 0.05). In conclusion, baseline U-Cd levels were not independently associated with new-onset diabetes in this large Asian cohort. These results suggest that chronic Cd exposure may not be a significant risk factor for diabetes in this population.
Shing-Hsien Chou, Cheng-Wei Lin, Fu-Chih Hsiao et al.· Ecotoxicology and Environmen...· 0 citations
This study used Census data from Northern Ireland linked to administrative data on prescriptions between 2010 and 2016, to examine the association between ambient air pollution exposure and the risk of dementia onset. It contributes to this literature by providing new evidence in a comparatively low pollution context, using rich and nationally representative cohort data with comprehensive information on dementia disease medications dispensed over an extended period. We estimated Cox Proportional Hazards models for the association between pollution exposure and dementia onset as proxied by first receipt of dementia medication, controlling extensively for potentially confounding factors. Estimates are presented in the form of hazard ratios for the effect of long-term PM2.5 and NO2 exposure (define as 5-year moving average exposure in the primary model) on the risk of dementia onset. There was a clear unadjusted and adjusted association between long-term exposure to ambient pollution and the risk of developing dementia, with those experiencing higher exposures being at greater risk. There was evidence of a positive association with both PM2.5 and NO2 exposure for subsamples by age and sex with more tentative associations for those under 70 years of age. This study contributes to an emerging literature examining the association between ambient PM2.5 and NO2 pollution and onset of dementia. We found strong evidence for positive associations even in the relatively low-pollution context of Northern Ireland.
Babak Jahanshahi, Duncan McVicar, Neil Rowland· International Journal of Pop...· 0 citations
BACKGROUND
Air pollution is an established risk factor for cardiovascular and metabolic diseases, but evidence on chronic kidney diseases (CKD) remains limited.
OBJECTIVE
We aim to examine the association between long-term exposure to air pollutants and CKD incidence.
METHODS
We followed 24,581 female nurses from the Danish Nurse Cohort, recruited in 1993 or 1999, for their first-ever hospital contact with a primary or secondary CKD diagnosis until 2018. We estimated annual mean levels of particulate matter with a diameter < 2.5 µm (PM2.5) and 10 µm (PM10), nitrogen dioxide (NO2), and black carbon (BC) at nurses' residential addresses using the DEHM/UBM/AirGIS modeling system. We used Cox regression models to examine the association of 14-year running means of air pollutants with CKD incidence and to explore the effect modification of this association by lifestyles.
RESULTS
Over 521,211 person-years of follow-up, 429 nurses developed CKD. We found positive associations of modest magnitude between long-term exposure to air pollutants and CKD, with hazard ratios (95% confidence intervals) per interquartile range: 1.18 (0.93-1.50) per 2.86 µg/m3 for PM2.5, 1.14 (0.93-1.40) per 3.33 µg/m3 for PM10, 1.13 (0.99-1.28) per 8.09 µg/m3 for NO2, and 1.09 (1.00-1.20) per 0.34 µg/m3 for BC. The associations between long-term exposure to NO2 and CKD incidence were greater in never smokers than in ever-smokers. Associations with NO2 and BC remained unchanged in two-pollutant models, whereas those with PM10 and PM2.5 attenuated.
SIGNIFICANCE
Our study adds important new findings to the growing evidence suggesting that air pollution may be associated with CKD incidence.
IMPACT STATEMENT
This study provides longitudinal evidence that long-term exposure to ambient air pollution contributes to chronic kidney disease (CKD) incidence, even in a relatively healthy occupational cohort and at comparatively low pollution levels. Although effect sizes were modest, consistent positive associations, particularly for NO2 and black carbon, highlight traffic-related pollution as a potential renal risk factor. Stronger associations among never-smokers suggest that environmental exposures may independently influence kidney health. These findings reinforce the need to integrate air pollution into CKD risk assessment and prevention strategies. Strengthening air quality policies and reducing long-term residential exposure could help lower CKD burden and protect kidney health at the population level.
Gonzalo Hevia-Ramos, Jiawei Zhang, Stephane Tuffier et al.· Journal of Exposure Science...· 0 citations
INTRODUCTION
Environmental exposures have been associated with type 2 diabetes (DM-2) prevalence, but associations for incidence remain inconclusive. This study examined the associations between environmental exposures (e.g. air pollution, greenness and traffic noise) and DM-2 incidence in a population where associations of these exposures with DM-2 prevalence have previously been established.
METHODS
Data of 249,495 Dutch individuals who participated in the Public Health Monitor in 2012 were used, enriched with data on air pollution, greenness, road traffic noise, and obesogenic environment. The incidence of DM-2 was based on medication prescriptions from 2013 to 2022. Cox regression models were performed to investigate the association between the exposures and DM-2 incidence. Potential effect modification by age (<40 years, 40-64 years, 65-79 years and ≥80 years) and sex was examined.
RESULTS
No significant associations were observed between the exposures and DM-2 incidence in the total population. No significant associations were also observed across age groups and men and women, except that greenness was statistically significantly associated with a lower DM-2 incidence (Hazard Ratio per interquartile range (HRIQR)=0.96, 95% confidence interval (CI)=[0.92;1.00]) in individuals aged 40-64 years.
CONCLUSION
In conclusion, a wide range of environmental exposures were not associated with DM-2 incidence. Therefore, our study on DM-2 incidence does not support the previously identified associations between environmental exposures and DM-2 prevalence.
A. P. Smit, B. Loef, J. Klompmaker et al.· Environmental Research· 0 citations