Long-term Exposure to Traffic-Related Air Pollution and Diabetes-Associated Mortality: A Cohort Study

Diabetologia. 2013 Jan;56(1):36-46. doi: 10.1007/s00125-012-2698-7. Epub 2012 Aug 24.


Aims/hypothesis: The aim of this study was to investigate whether air pollution from traffic at a residence is associated with mortality related to type 1 or type 2 diabetes.

Methods: We followed up 52,061 participants in the Danish Diet, Cancer and Health cohort for diabetes-related mortality in the nationwide Register of Causes of Death, from baseline in 1993-1997 up to the end of 2009, and traced their residential addresses since 1971 in the Central Population Registry. We used dispersion-modelled concentration of nitrogen dioxide (NO₂) since 1971 and amount of traffic at the baseline residence as indicators of traffic-related air pollution and used Cox regression models to estimate mortality-rate ratios (MRRs) with adjustment for potential confounders.

Results: Mean levels of NO₂ at the residence since 1971 were significantly associated with mortality from diabetes. Exposure above 19.4 μg/m³ (upper quartile) was associated with a MRR of 2.15 (95% CI 1.21, 3.83) when compared with below 13.6 μg/m³ (lower quartile), corresponding to an MRR of 1.31 (95% CI 0.98, 1.76) per 10 μg/m³ NO₂ after adjustment for potential confounders.

Conclusions/interpretation: This study suggests that traffic-related air pollution is associated with mortality from diabetes. If confirmed, reduction in population exposure to traffic-related air pollution could be an additional strategy against the global public health burden of diabetes.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Air Pollutants / toxicity*
  • Cohort Studies
  • Confounding Factors, Epidemiologic
  • Denmark / epidemiology
  • Diabetes Mellitus / epidemiology
  • Diabetes Mellitus / mortality*
  • Environmental Exposure / adverse effects*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Nitrogen Dioxide / toxicity
  • Proportional Hazards Models
  • Prospective Studies
  • Registries
  • Residence Characteristics
  • Surveys and Questionnaires
  • Time Factors
  • Urban Health
  • Vehicle Emissions / toxicity*


  • Air Pollutants
  • Vehicle Emissions
  • Nitrogen Dioxide