Impact of environmental factors on diabetes mortality: A comparison between inland and coastal areas

Wenxiu Zheng; Jie Chu; Hilary Bambrick; Ning Wang; Kerrie Mengersen; Xiaolei Guo; Wenbiao Hu

doi:10.1016/j.scitotenv.2023.166335

Impact of environmental factors on diabetes mortality: A comparison between inland and coastal areas

Sci Total Environ. 2023 Dec 15:904:166335. doi: 10.1016/j.scitotenv.2023.166335. Epub 2023 Aug 15.

Authors

Wenxiu Zheng¹, Jie Chu², Hilary Bambrick³, Ning Wang⁴, Kerrie Mengersen⁵, Xiaolei Guo⁶, Wenbiao Hu⁷

Affiliations

¹ Ecosystem Change and Population Health Research Group, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia.
² Shandong Center for Disease Control and Prevention, Academy of Preventive Medicine, Shandong University, Jinan, Shandong, China.
³ Ecosystem Change and Population Health Research Group, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia; National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia.
⁴ National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
⁵ School of Mathematical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia.
⁶ Shandong Center for Disease Control and Prevention, Academy of Preventive Medicine, Shandong University, Jinan, Shandong, China. Electronic address: guoxiaolei@126.com.
⁷ Ecosystem Change and Population Health Research Group, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia. Electronic address: w2.hu@qut.edu.au.

PMID: 37591381
DOI: 10.1016/j.scitotenv.2023.166335

Abstract

Background: Diabetes mortality varies between coastal and inland areas in Shandong Province, China. However, evidence about the reasons for this disparity is limited. We assume that distinct environmental conditions may contribute to the disparities in diabetes mortality patterns between coastal and inland areas.

Method: Qingdao and Jinan were selected as typical coastal and inland cities in Shandong Province, respectively, with similar socioeconomic but different environmental characteristics. Data on diabetes deaths and environmental factors (i.e., temperature, relative humidity and air pollution particles with a diameter of 2.5 μm or less (PM_2.5)) were collected from 2013 to 2020. Spatial kriging methods were used to estimate the aggregated diabetes mortality at the city level. A distributed lag non-linear model (DLNM) was used to quantify the possible cumulative and non-cumulative associations between environmental factors and diabetes mortality by age, sex and location.

Results: In the coastal city (Qingdao), the maximum cumulative relative risks (RRs) of temperature and PM_2.5 associated with diabetes deaths were 2.54 (95 % confidence interval (CI): 1.25-5.15), and 1.17 (95 % CI: 1.01-1.37) respectively, at lag 1 week. In the inland city (Jinan), only temperature exhibited significant cumulative associations with diabetes deaths (RR = 1.54, 95 % CI: 1.07-2.23 at 29 °C). Lower relative humidity (22 %-45 %) had a lag-specific association with diabetes deaths in inland areas at lag 3 weeks (RR = 1.33, 95 % CI: 1.03-1.70 at 22 %).

Conclusion: Despite the lower PM_2.5 concentrations in the coastal location, diabetes mortality exhibited stronger links to environmental variables in the coastal city than in the inland city. These findings suggest that the control of air pollution could decrease the mortality burden of diabetes, even in the region with relatively good air quality. Additionally, the spatial estimation method is recommended to identify associations between environmental factors and diseases in studies with limited data.

Keywords: Coastal; Diabetes mortality; Inland; PM(2.5); Temperature; Time-series.

MeSH terms

Air Pollutants* / adverse effects
Air Pollutants* / analysis
Air Pollution* / adverse effects
Air Pollution* / analysis
China / epidemiology
Diabetes Mellitus* / epidemiology
Humans
Particulate Matter / analysis
Temperature

Substances

Particulate Matter
Air Pollutants