Short-term Exposure to Wildfire-Specific PM2.5 and Diabetes Hospitalization: A Study in Multiple Countries and Territories

Author:

Zhang Yiwen1ORCID,Xu Rongbin1,Huang Wenzhong1,Morawska Lidia2,Johnston Fay H.3,Abramson Michael4,Knibbs Luke56,Matus Patricia7,Ye Tingting1,Yu Wenhua1,Hales Simon8,Morgan Geoffrey5,Yang Zhengyu1,Liu Yanming1,Ju Ke1,Yu Pei1,Lavigne Eric910,Wu Yao1,Wen Bo1,Zhang Yuxi11ORCID,Heyworth Jane12,Marks Guy13,Saldiva Paulo H.N.14,Coelho Micheline S.Z.S.14,Guo Yue Leon15ORCID,Song Jiangning16,Guo Yuming1ORCID,Li Shanshan1

Affiliation:

1. 1Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia

2. 2School of Earth and Atmospheric Sciences, Queensland University of Technology, Brisbane, Queensland, Australia

3. 3Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia

4. 4School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia

5. 5Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia

6. 6Public Health Research Analytics and Methods for Evidence, Public Health Unit, Sydney Local Health District, Camperdown, New South Wales, Australia

7. 7School of Medicine, University of the Andes (Chile), Las Condes, Región Metropolitana, Chile

8. 8Department of Public Health, University of Otago, Wellington, New Zealand

9. 9School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada

10. 10Environmental Health Science and Research Bureau, Health Canada, Ottawa

11. 11School of Life and Environmental Sciences, University of Sydney, Sydney, New South Wales, Australia

12. 12Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Western Australia, Australia

13. 13School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia

14. 14Department of Pathology, School of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil

15. 15Environmental and Occupational Medicine, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan

16. 16Department of Biochemistry and Molecular Biology, Monash Biomedicine Discovery Institute, Monash University, Melbourne, Victoria, Australia

Abstract

OBJECTIVE To evaluate associations of wildfire fine particulate matter ≤2.5 mm in diameter (PM2.5) with diabetes across multiple countries and territories. RESEARCH DESIGN AND METHODS We collected data on 3,612,135 diabetes hospitalizations from 1,008 locations in Australia, Brazil, Canada, Chile, New Zealand, Thailand, and Taiwan during 2000–2019. Daily wildfire-specific PM2.5 levels were estimated through chemical transport models and machine-learning calibration. Quasi-Poisson regression with distributed lag nonlinear models and random-effects meta-analysis were applied to estimate associations between wildfire-specific PM2.5 and diabetes hospitalization. Subgroup analyses were by age, sex, location income level, and country or territory. Diabetes hospitalizations attributable to wildfire-specific PM2.5 and nonwildfire PM2.5 were compared. RESULTS Each 10 µg/m3 increase in wildfire-specific PM2.5 levels over the current day and previous 3 days was associated with relative risks (95% CI) of 1.017 (1.011–1.022), 1.023 (1.011–1.035), 1.023 (1.015–1.032), 0.962 (0.823–1.032), 1.033 (1.001–1.066), and 1.013 (1.004–1.022) for all-cause, type 1, type 2, malnutrition-related, other specified, and unspecified diabetes hospitalization, respectively. Stronger associations were observed for all-cause, type 1, and type 2 diabetes in Thailand, Australia, and Brazil; unspecified diabetes in New Zealand; and type 2 diabetes in high-income locations. An estimate of 0.67% (0.16–1.18%) and 1.02% (0.20–1.81%) for all-cause and type 2 diabetes hospitalizations were attributable to wildfire-specific PM2.5. Compared with nonwildfire PM2.5, wildfire-specific PM2.5 posed greater risks of all-cause, type 1, and type 2 diabetes and were responsible for 38.7% of PM2.5-related diabetes hospitalizations. CONCLUSIONS We show the relatively underappreciated links between diabetes and wildfire air pollution, which can lead to a nonnegligible proportion of PM2.5-related diabetes hospitalizations. Precision prevention and mitigation should be developed for those in advantaged communities and in Thailand, Australia, and Brazil.

Funder

Australian Research Council

Publisher

American Diabetes Association

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