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The Association Between PM2.5 and Ozone and the Prevalence of Diabetes Mellitus in the United States, 2002 to 2008

Hernandez, Ashley M., MSPH; Gimeno Ruiz de Porras, David, PhD; Marko, Dritana, MD; Whitworth, Kristina W., PhD

Journal of Occupational and Environmental Medicine: July 2018 - Volume 60 - Issue 7 - p 594–602
doi: 10.1097/JOM.0000000000001332

Objective: To examine the association between air pollution and diabetes prevalence in the United States, 2002 to 2008.

Methods: Annual average particulate matter (PM2.5) and ozone concentrations were calculated using daily county-level data from the CDC's Tracking Network. Individual-level outcome and covariate data were obtained from the Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System for 862,519 individuals. We used Poisson regression analyses to examine associations between each air pollutant (per 10-unit increase) with diabetes, including regional sub-analyses. Analyses were adjusted for year, age, sex, race, ethnicity, education, income, smoking status, body mass index, exercise, and asthma.

Results: Positive associations between each pollutant and diabetes were found (PM2.5: prevalence ratio [PR] = 1.10; 95% confidence interval [CI] = 1.03, 1.17; ozone: PR = 1.06; 95% CI = 1.03, 1.09). There was limited evidence of effect modification by region.

Conclusions: Interventions to reduce ambient air pollution may help alleviate the diabetes burden in the US.

Department of Epidemiology Human Genetics and Environmental Sciences, UTHealth School of Public Health in San Antonio, San Antonio (Ms Hernandez, Dr Gimeno Ruiz de Porras, Dr Whitworth); Southwest Center for Occupational and Environmental Health (SWCOEH) (Dr Gimeno Ruiz de Porras, Dr Whitworth); Center for Research in Occupational Health (CISAL), Universitat Pompeu Fabra, Barcelona (Dr Gimeno Ruiz de Porras); Centro de Investigacion Biomedica en Red de Epidemiologia y Salud Publica (CIBERESP) (Dr Gimeno Ruiz de Porras), Spain; Department of Management, Policy and Community Health (Dr Marko); Institute for Health Policy, UTHealth School of Public Health (Dr Marko), Houston, Texas.

Address correspondence to: Ashley M. Hernandez, MSPH, Division of Environmental Health Sciences, University of Minnesota School of Public Health, Mayo Memorial Building MMC807, 420 Delaware Street S.E., Minneapolis, MN 55455 (

Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Drs David Gimeno Ruiz de Porras and Kristina Whitworth were partially supported by a Centers for Disease Control and Prevention/National Institute for Occupational Safety and Health (CDC/NIOSH) Education and Research Center Grant No. 5T42OH008421 to the SWCOEH.

Authors Hernandez, Gimeno Ruiz de Porras, Marko, and Whitworth have no relationships/conditions/circumstances that present potential conflict of interest.

The JOEM editorial board and planners have no financial interest related to this research.

Copyright © 2018 by the American College of Occupational and Environmental Medicine