Life-course Associations between Ambient Fine Particulate Matter and the Prevalence of Prediabetes and Diabetes: A Longitudinal Cohort Study in Taiwan and Hong Kong

Objective: Both air pollution and diabetes are key urban challenges. The association between PM2.5 exposure and prediabetes/diabetes in adults is well-documented, but the health effects of life-course exposure remain unclear. This study evaluated the impact of PM2.5 exposure throughout various life stages on the prevalence of prediabetes/diabetes in adulthood.

Research Design and Methods: We included 4,551 individuals with 19,593 medical visits from two open cohorts in Taiwan (TW) and Hong Kong (HK) between 2000 and 2018. Ambient PM2.5 exposure was assessed using a satellite-based model, delivering a 2-year average exposure at a resolution of 1 km2. Logistic mixed-effects models were used to investigate longitudinal associations between PM2.5 exposure and the prevalence of prediabetes/diabetes. Life-course models were used to examine the impact of PM2.5 exposure at different life stages on prediabetes/diabetes in adulthood.

Results: Over an average follow-up period of 9.93 years, 1,660 individuals with prediabetes/diabetes were observed. For the longitudinal association, every 10μg/m3 increase in PM2.5 was associated with increased odds of having prediabetes/diabetes (Odds ratio [OR]:1.32, 95% confidence interval [CI]: 1.13–1.54). The odds of adulthood prediabetes/diabetes increased by 15%, 18%, and 29% for each 10μg/m3 increase in PM2.5 exposure during school age, adolescence, and adulthood, respectively.

Conclusions: Our findings suggest a link between PM2.5 exposure during each life stage and the prevalence of prediabetes/diabetes in adulthood, with the health impacts of exposure during adulthood being slightly greater. This study underscores the need for life-course air pollution control strategies to mitigate the substantial disease burden of diabetes.