医学
2型糖尿病
危险系数
混淆
比例危险模型
前瞻性队列研究
入射(几何)
人口学
队列
队列研究
环境卫生
糖尿病
审查(临床试验)
内科学
置信区间
数学
内分泌学
社会学
病理
几何学
作者
Karla Cervantes-Martínez,Dalia Stern,José Salvador Zamora-Muñoz,Ruy López‐Ridaura,José Luis Texcalac-Sangrador,Adrian Cortés-Valencia,Jorge Octavio Acosta-Montes,Martín Lajous,Horacio Riojas-Rodríguez
标识
DOI:10.1016/j.scitotenv.2021.151833
摘要
Air pollution is a risk factor for type 2 diabetes (T2D). However, scarse longitudinal studies have evaluated this association in low- and middle-income countries, where 80% of the worldwide cases of T2D occur.Our aim was to estimate the association between PM2.5 and NO2 exposure and incident T2D, in the Mexican Teachers' Cohort (MTC).We selected a subsample of female teachers from the MTC from Mexico City metropolitan area (MCMA), recruited in 2008 and with active follow-up every three years. We assigned the monthly time-weighted exposures (PM2.5 and NO2) using home and work addresses, until failure, censoring or death. We developed two high resolution (1 × 1-km) spatiotemporal predictive generalized additive models of PM2.5 and NO2. Incident diabetes was identified through self-report and two administrative databases of registered diabetes patients. We fitted time-varying Cox models to estimate hazard ratios of the relation between PM2.5 and NO2 and incident T2D, adjusting for confounding variables that were identified using a causal model.A total of 13,669 teachers were followed-up for a maximum of 11.5 years, over which 996 incident T2D cases (88 cases per 100,000 person-months) occurred. Incident T2D increased by 72% (HR = 1.72 [1.47-2.01]) for each 10 μg/m3 increase of PM2.5, and 52% for each 10 ppb of NO2 (HR = 1.52 [1.37-1.68]).Mid-term exposure to PM2.5 and NO2 was associated with a higher risk of T2D after adjusting for indoor wood smoke, socioeconomic status, and physical activity. These associations were attenuated in two-pollutant models but remained positive when evaluated long-term exposure. This is the first prospective study to evaluate T2D risk by exposure to both pollutants, PM2.5 and NO2 in a population from an upper middle-income country in the Americas.
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