Association of residential air pollution and green space with all-cause and cause-specific mortality in individuals with diabetes: an 11-year prospective cohort study

作者：Chunfeng Wu, Jiangdong Liu, Yanyun Li, Luxin Qin, Ruilong Gu, Jiachen Feng, Lulu Xu, Xia Meng, Jiaxin Chen, Renjie Chen, Yan Shi, Haidong Kan · 发表于：EBioMedicine · 年份：2024 · DOI：10.1016/j.ebiom.2024.105376 · 被引用次数：26 · 研究领域：Urban Green Space and Health、Air Quality and Health Impacts、Climate Change and Health Impacts

Background To assess the long-term impact of residential air pollution and green space exposure on cause-specific mortality in individuals with type 2 diabetes mellitus (T2DM). Methods This study includes 174,063 participants newly diagnosed with T2DM from a prospective cohort in Shanghai, China, enrolled between 2011 and 2013. Residential annual levels of air pollutants, including fine (PM 2.5 ) and coarse (PM 2.5-10 ) particulate matter, nitrogen dioxide (NO 2 ), along with the normalized difference vegetation index (NDVI), were derived from satellite-based exposure models. Findings During a median follow-up of 7.9 years (equivalent to 1,333,343 person-years), this study recorded 22,205 deaths. Higher exposure to PM 2.5 was significantly associated with increased risks for all mortality outcomes, whilst PM 2.5-10 showed no significant impacts. The strongest associations of PM 2.5 were observed for diabetes with peripheral vascular diseases [hazard ratio (HR): 2.70; per 10 μg/m 3 increase] and gastrointestinal cancer (2.44). Effects of NO 2 became significant at concentrations exceeding approximately 45 μg/m³, with the highest associations for lung cancer (1.20) and gastrointestinal cancer (1.19). Conversely, each interquartile range increase in NDVI (0.10) was linked to reduced mortality risks across different causes, with HRs ranging from 0.76 to 1.00. The association between greenness and mortality was partly and significantly mediated by reduced PM 2.5 (23.80%) and NO 2 ...