Association Between Fine Particulate Matter and Diabetes Prevalence in the U.S.

  1. John S. Brownstein, PHD1,4,6,7
  1. 1Children's Hospital Informatics Program at the Harvard-MIT Division of Health Sciences and Technology, Boston, Massachusetts,
  2. 2St. George's University School of Medicine, Grenada, West Indies;
  3. 3Yale University School of Medicine, New Haven, Connecticut;
  4. 4Partners Healthcare, Boston, Massachusetts;
  5. 5Joslin Diabetes Center, Boston, Massachusetts;
  6. 6Division of Emergency Medicine, Children's Hospital Boston, Boston, Massachusetts;
  7. 7Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
  1. Corresponding author: John S. Brownstein, john_brownstein{at}


OBJECTIVE Recent studies have drawn attention to the adverse effects of ambient air pollutants such as particulate matter 2.5 (PM2.5) on human health. We evaluated the association between PM2.5 exposure and diabetes prevalence in the U.S. and explored factors that may influence this relationship.

RESEARCH DESIGN AND METHODS The relationship between PM2.5 levels and diagnosed diabetes prevalence in the U.S. was assessed by multivariate regression models at the county level using data obtained from both the Centers for Disease Control and Prevention (CDC) and U.S. Environmental Protection Agency (EPA) for years 2004 and 2005. Covariates including obesity rates, population density, ethnicity, income, education, and health insurance were collected from the U.S. Census Bureau and the CDC.

RESULTS Diabetes prevalence increases with increasing PM2.5 concentrations, with a 1% increase in diabetes prevalence seen with a 10 μg/m3 increase in PM2.5 exposure (2004: β = 0.77 [95% CI 0.39–1.25], P < 0.001; 2005: β = 0.81 [0.48–1.07], P < 0.001). This finding was confirmed for each study year in both univariate and multivariate models. The relationship remained consistent and significant when different estimates of PM2.5 exposure were used. Even for counties within guidelines for EPA PM2.5 exposure limits, those with the highest exposure showed a >20% increase in diabetes prevalence compared with that for those with the lowest levels of PM2.5, an association that persisted after controlling for diabetes risk factors.

CONCLUSIONS Our results suggest PM2.5 may contribute to increased diabetes prevalence in the adult U.S. population. These findings add to the growing evidence that air pollution is a risk factor for diabetes.


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  • Received April 12, 2010.
  • Accepted July 5, 2010.

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  1. Diabetes Care vol. 33 no. 10 2196-2201
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