Estimates, trends, and drivers of the global burden of type 2 diabetes attributable to PM2·5 air pollution, 1990–2019: an analysis of data from the Global Burden of Disease Study 2019
Katrin Burkart, Kate Causey, Aaron J. Cohen, Sarah S Wozniak, Devashri Salvi, Cristiana Abbafati, Victor Adekanmbi, José Carmelo Adsuar, Keivan Ahmadi, Fares Alahdab, Ziyad Al‐Aly, Vahid Alipour, Nelson Alvis‐Guzmán, A. Kofi Amegah, Cătălina Liliana Andrei, Tudorel Andrei, Fereshteh Ansari, Jalal Arabloo, Olatunde Aremu, Timur Aripov, Ebrahim Babaee, Maciej Banach, Anthony Barnett, Till Bärnighausen, Neeraj Bedi, Masoud Behzadifar, Yannick Béjot, Derrick Bennett, Isabela M. Benseñor, Robert S. Bernstein, Krittika Bhattacharyya, Ali Bijani, Antonio Biondi, Somayeh Bohlouli, Susanne Breitner, Hermann Brenner, Zahid A Butt, Luis Alberto Cámera, Carlos Cantú‐Brito, Félix Carvalho, Ester Cerin, Vijay Kumar Chattu, Bal Govind Chauhan, Jee-Young Jasmine Choi, Dinh‐Toi Chu, Xiaochen Dai, Lalit Dandona, Rakhi Dandona, Ahmad Daryani, Kairat Davletov, Barbora de Courten, Feleke Mekonnen Demeke, Edgar Denova‐Gutiérrez, Samath Dhamminda Dharmaratne, Meghnath Dhimal, Daniel Díaz, Shirin Djalalinia, Bruce Bartholow Duncan, Maysaa El Sayed Zaki, Sharareh Eskandarieh, Mohammad Fareed, Farshad Farzadfar, Nazir Fattahi, Mehdi Fazlzadeh, Eduarda Fernandes, Irina Filip, Florian Fischer, Nataliya A Foigt, Marisa Freitas, Ahmad Ghashghaee, Paramjit Gill, Ibrahim Ginawi, Sameer Vali Gopalani, Yuming Guo, Rajat Das Gupta, Tesfa Dejenie Habtewold, Randah R Hamadeh, Samer Hamidi, Graeme J. Hankey, Edris Hasanpoor, Hamid Yimam Hassen, Simon I Hay, Behzad Heibati, Michael K. Hole, Naznin Hossain, Mowafa Househ, Seyed Sina Naghibi Irvani, Jalil Jaafari, Mihajlo Jakovljević, Ravi Prakash Jha, Jost B. Jonas, Jacek Jerzy Jozwiak, Amir Kasaeian, Neda Kaydi, Yousef Khader, Morteza Abdullatif Khafaie, Ejaz Ahmad Khan, Junaid Khan, Md Nuruzzaman Khan, Khaled Khatab
Abstract
Background Experimental and epidemiological studies indicate an association between exposure to particulate matter (PM) air pollution and increased risk of type 2 diabetes. In view of the high and increasing prevalence of diabetes, we aimed to quantify the burden of type 2 diabetes attributable to PM 2·5 originating from ambient and household air pollution. Methods We systematically compiled all relevant cohort and case-control studies assessing the effect of exposure to household and ambient fine particulate matter (PM 2·5 ) air pollution on type 2 diabetes incidence and mortality. We derived an exposure–response curve from the extracted relative risk estimates using the MR-BRT (meta-regression—Bayesian, regularised, trimmed) tool. The estimated curve was linked to ambient and household PM 2·5 exposures from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019, and estimates of the attributable burden (population attributable fractions and rates per 100 000 population of deaths and disability-adjusted life-years) for 204 countries from 1990 to 2019 were calculated. We also assessed the role of changes in exposure, population size, age, and type 2 diabetes incidence in the observed trend in PM 2·5 -attributable type 2 diabetes burden. All estimates are presented with 95% uncertainty intervals. Findings In 2019, approximately a fifth of the global burden of type 2 diabetes was attributable to PM 2·5 exposure, with an estimated 3·78 (95% uncertainty interval 2·68–4·83) deaths per 100 000 population and 167 (117–223) disability-adjusted life-years (DALYs) per 100 000 population. Approximately 13·4% (9·49–17·5) of deaths and 13·6% (9·73–17·9) of DALYs due to type 2 diabetes were contributed by ambient PM2·5, and 6·50% (4·22–9·53) of deaths and 5·92% (3·81–8·64) of DALYs by household air pollution. High burdens, in terms of numbers as well as rates, were estimated in Asia, sub-Saharan Africa, and South America. Since 1990, the attributable burden has increased by 50%, driven largely by population growth and ageing. Globally, the impact of reductions in household air pollution was largely offset by increased ambient PM 2·5 . Interpretation Air pollution is a major risk factor for diabetes. We estimated that about a fifth of the global burden of type 2 diabetes is attributable PM 2·5 pollution. Air pollution mitigation therefore might have an essential role in reducing the global disease burden resulting from type 2 diabetes. Funding Bill & Melinda Gates Foundation.