Ambient Ozone and Incident Diabetes: A Prospective Analysis in a Large Cohort of African American Women

Environ Int. 2017 May;102:42-47. doi: 10.1016/j.envint.2016.12.011. Epub 2017 Jan 30.


Background: Ozone is a ubiquitous air pollutant with increasing concentrations in many populous regions. Toxicological studies show that ozone can cause oxidative stress and increase insulin resistance. These pathways may contribute to metabolic changes and diabetes formation. In this paper, we investigate the association between ozone and incident type 2 diabetes in a large cohort of African American women.

Methods: We used Cox proportional hazards models to calculate hazard ratios (HRs) for incident type 2 diabetes associated with exposure to ozone in a cohort of 45,231 African American women living in 56 metropolitan areas across the United States. Ozone levels were estimated using the U.S. EPA Models-3/Community Multiscale Air Quality (CMAQ) predictions fused with ground measurements at a resolution of 12km for the years 2007-2008.

Results: The HR per interquartile range increment of 6.7ppb of ozone was 1.18 (95% CI 1.04-1.34) for incident diabetes in adjusted models. This association was unaltered in models that controlled for fine particulate matter with diameter <2.5μm (PM2.5). Associations were modified by nitrogen dioxide (NO2) levels, such that HRs for ozone levels were larger in areas of lower NO2.

Conclusions: Our results provide initial evidence of a positive association between O3 and incident diabetes in African American women. Given the ubiquity of ozone exposure and the importance of diabetes on quality of life and survival, these results may have important implications for the protection of public health.

Keywords: African American women; Air pollution; Diabetes; Exposure; Ozone.

MeSH terms

  • Adult
  • African Americans*
  • Aged
  • Air Pollutants / analysis*
  • Cohort Studies
  • Diabetes Mellitus, Type 2 / epidemiology*
  • Diabetes Mellitus, Type 2 / ethnology
  • Female
  • Humans
  • Inhalation Exposure / analysis*
  • Middle Aged
  • Nitrogen Dioxide / analysis
  • Ozone / analysis*
  • Particulate Matter / analysis*
  • Proportional Hazards Models
  • Prospective Studies
  • Quality of Life
  • Surveys and Questionnaires
  • United States
  • Young Adult


  • Air Pollutants
  • Particulate Matter
  • Ozone
  • Nitrogen Dioxide