Exposure to Ambient Ultrafine Particles and Nitrogen Dioxide and Incident Hypertension and Diabetes

Epidemiology. 2018 May;29(3):323-332. doi: 10.1097/EDE.0000000000000798.


Background: Previous studies reported that long-term exposure to traffic-related air pollution may increase the incidence of hypertension and diabetes. However, little is known about the associations of ultrafine particles (≤0.1 μm in diameter) with these two conditions.

Methods: We conducted a population-based cohort study to investigate the associations between exposures to ultrafine particles and nitrogen dioxide (NO2) and the incidence of diabetes and hypertension. Our study population included all Canadian-born residents aged 30 to 100 years who lived in the City of Toronto, Canada, from 1996 to 2012. Outcomes were ascertained using validated province-wide databases. We estimated annual concentrations of ultrafine particles and NO2 using land-use regression models and assigned these estimates to participants' annual postal code addresses during the follow-up period. Using random-effects Cox proportional hazards models, we calculated hazard ratios (HRs) and 95% confidence intervals (CIs) for ultrafine particles and NO2, adjusted for individual- and neighborhood-level covariates. We considered both single- and multipollutant models.

Results: Each interquartile change in exposure to ultrafine particles was associated with increased risk of incident hypertension (HR = 1.03; 95% CI = 1.02, 1.04) and diabetes (HR = 1.06; 95% CI = 1.05, 1.08) after adjusting for all covariates. These results remained unaltered with further control for fine particulate matter (≤2.5 μm; PM2.5) and NO2. Similarly, NO2 was positively associated with incident diabetes (HR = 1.06; 95% CI = 1.05, 1.07) after controlling for ultrafine particles and PM2.5.

Conclusions: Exposure to traffic-related air pollution including ultrafine particles and NO2 may increase the risk for incident hypertension and diabetes. See video abstract at, http://links.lww.com/EDE/B337.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Air Pollution / adverse effects
  • Canada / epidemiology
  • Cohort Studies
  • Diabetes Mellitus / chemically induced*
  • Diabetes Mellitus / epidemiology
  • Environmental Exposure / adverse effects*
  • Female
  • Humans
  • Hypertension / chemically induced*
  • Hypertension / epidemiology
  • Inhalation Exposure / adverse effects*
  • Male
  • Middle Aged
  • Nitrogen Dioxide / adverse effects*
  • Particle Size*
  • Particulate Matter / analysis*


  • Particulate Matter
  • Nitrogen Dioxide