Chinese Medical Sciences Journal ›› 2022, Vol. 37 ›› Issue (3): 218-227.doi: 10.24920/004065
收稿日期:
2022-01-20
接受日期:
2022-05-31
出版日期:
2022-09-30
发布日期:
2022-06-20
通讯作者:
李乃适
E-mail:lns@medmail.com.cn
Zihan Chen1,Zhou Zhao1,2,Chuiwen Deng3,Naishi Li1,*()
Received:
2022-01-20
Accepted:
2022-05-31
Published:
2022-09-30
Online:
2022-06-20
Contact:
Naishi Li
E-mail:lns@medmail.com.cn
摘要:
目的 研究指出空气污染是2型糖尿病的危险因素。本文采用Meta分析方法评价发展中国家空气污染与2型糖尿病之间的联系。
方法 使用计算机检索PubMed、EMBASE和Web of Science数据库内截至2022年03月31日发表的发展中国家空气污染与2型糖尿病患病率或发病率之间关系的研究论文。使用比值比(OR)来评估疗效,对纳入的研究进行Meta分析。
结果 共纳入在发展中国家进行的8项横断面研究和8项队列研究。对8项PM2.5相关的研究进行的Meta分析显示,暴露于PM2.5使2型糖尿病患病率增加,相关性为1.12(95% CI 1.07,1.17)(P<0.001)。由于纳入文献数量有限,未能定量评价空气污染与2型糖尿病发病率之间的相关性。
结论 在发展中国家,暴露于PM2.5会导致2型糖尿病患病率增加。糖尿病易感人群应该注意减少空气污染暴露。
Zihan Chen, Zhou Zhao, Chuiwen Deng, Naishi Li. Association between Air Pollution and Type 2 Diabetes Mellitus in Developing Countries: A Systematic Review and Meta-Analysis[J].Chinese Medical Sciences Journal, 2022, 37(3): 218-227.
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Author and year | Study design | Location | Participants | Study period | Pollutants | Average exposure | Effect estimate (95% CI) | Outcomes | Definition of diabetes |
---|---|---|---|---|---|---|---|---|---|
Bo Y, et al(2021)[ | Cohort | Taiwan, China | 146,789 | 2001 - 2014 | PM2.5 | 27μg/m3 | 1.28 (1.19, 1.39) | T2DM incidence | Self-report of physician-diagnosed T2DM |
Chilian-Herrera OL, et al (2021)[ | Cohort | Municipalities of the State of Mexico and Mexico City | 2,297 | 2006 - 2012 | PM2.5 | 24.8μg/m3 | 3.09 (1.17, 8.15) | DM prevalence | Self-report information of “having received a medical diagnosis of diabetes or high blood sugar” |
Hassanvand MS, et al(2017)[ | Cross-sectional | 5 large cities in Iran | 2,916 | 2006 - 2011 | PM10 | 120.15μg/m3(study group), 83.95μg/m3(control group) | 1.32 (1.03, 1.69) | T2DM prevalence | Defined as a positive response to either of the following two questions: 1) “Have you ever been told by a doctor or other health worker that you have diabetes?”; 2) “Are you currently taking oral medication or insulin for diabetes prescribed by a doctor or other healthcare professional?” |
Jabbari F, et al (2020)[ | Cohort | Municipal district 13 of Tehran, Iran | 2,428 | 2009 - 2011 | PM10 | 82.6μg/m3 | 1.50 (1, 2.32) | T2DM incidence | Defined as the concentration of FBG ≥ 126 mg/dL, non-FBG ≥ 200 mg/dL, and regular use of glucose-lowering medication |
Jacob AM, et al (2019)[ | Cross-sectional | Chennai, Tamil Nadu, India | 410 | 2017 - 2018 | PM2.5 | 74.22μg/m3(study group) 27.22μg/m3 (control group) | 2.19 (1.40, 2.43) | T2DM prevalence | Meeting either of the following two criteria: 1) RCBG ≥ 140 mg/dl (7.8 mmol/l); 2) RCBG >200 mg/ dl (11.1 mmol/l) and reporting any one of the classic symptoms or weight loss |
Liu C, et al(2016)[ | Cross-sectional | 150 counties or districts from 28 provinces, China | 11,847 | 2011 - 2012 | PM2.5 | 72.6μg/m3 | 1.14 (1.08, 1.20) | T2DM prevalence | Self-reported diabetes, and/or FBG ≥7 mmol/L, and/or HbA1c ≥ 6.5%, and/or insulin use according to ADA’s recommendation |
Liu F, et al (2019)[ | Cohort | Rural areas of Henan province, China | 39,259 | 2015 - 2017 | PM1 | 57.4μg/m3 | 1.040 (1.026, 1.054) | T2DM prevalence | Previously diagnosed with T2DM and currently using antidiabetic medicines and/or FBG ≥ 7.0 mmol/L |
PM2.5 | 73.4μg/m3 | 1.068 (1.052, 1.084) | |||||||
NO2 | 39.9μg/m3 | 1.050 (1.039, 1.061) | |||||||
Li CY, et al(2019)[ | Cohort | Taiwan, China | 505,151 | 2001 - 2012 | PM2.5 | 27.28μg/m3 | 1.08 (1.06, 1.10) | T2DM incidence | Based on ICD-9 |
Li YL, et al(2021)[ | Cohort | Taiwan, China | 6,426,802 | 2005 - 2010 | O3 | 26.21ppb | 1.058 (1.053, 1.064) | T2DM incidence | Based on ICD-9 |
SO2 | 4.77ppb | 1.011 (1.007, 1.015) | |||||||
Qiu H, et al(2018)[ | Cohort | Hong Kong, China | 61,447 | 1998 - 2001 | PM2.5 | 35.8μg/m3 | 1.06 (1.01, 1.11) | T2DM prevalence | Based on ICD-9 |
1.15 (1.05, 1.25) | T2DM incidence | ||||||||
Shan A, et al (2020)[ | Cohort | Four cities in northern China | 38,529 | 1998 - 2009 | PM10 | 143.36μg/m3 | 1.831 (1.778, 1.886) | T2DM incidence | Self-reported physician diagnosis (from at least a class three hospital), intake of antidiabetic drugs or injection of insulin simultaneously |
SO2 | 66.71μg/m3 | 1.287 (1.256, 1.318) | |||||||
NO2 | 40.74μg/m3 | 1.472 (1.419, 1.528) | |||||||
Suryadhi MAH, et al(2020)[ | Cross-sectional | 487 regencies/ municipalities in all 33 provinces in Indonesia | 647,947 | 2007 - 2013 | PM2.5 | 8.3μg/m3 | 1.09 (1.05, 1.14) | DM prevalence | Using the following question “Have you ever been diagnosed with diabetes mellitus by a doctor?” |
Wang M, et al (2020)[ | Cross-sectional | Jinchang city, Gansu province, China | 19,884 | 2011 - 2013 | PM10 | 109.43μg/m3 | 1.17 (1.08, 1.26) | DM incidence | Defined according to the diagnostic criteria recommended by ADA as FBG ≥ 7.0 mmol/L and/or self-report clinical diagnosed of diabetes and/or self-report used of anti-diabetes drugs |
Yang BY, et al (2018)[ | Cross-sectional | Liaoning province, China | 15,477 | 2009 | PM1 | 66.0μg/m3 | 1.13 (1.04, 1.22) | DM prevalence | Defined according to ADA’s recommendations, as FBG ≥ 7.0 mmol/L or 2 h glucose ≥ 11.1mmol/L, or intake of any antidiabetic medication (both insulin and oral antidiabetic drugs), or both |
PM2.5 | 82.0μg/m3 | 1.14 (1.03, 1.25) | |||||||
PM10 | 123.1μg/m3 | 1.20 (1.12, 1.28) | |||||||
SO2 | 54.4μg/m3 | 1.12 (1.04, 1.21) | |||||||
NO2 | 35.3μg/m3 | 1.22 (1.12, 1.33) | |||||||
O3 | 49.4μg/m3 | 1.14 (1.05, 1.25) | |||||||
Yang Y, et al (2018)[ | Cross-sectional | 8 provinces across China | 11,504 | 2007 - 2010 | PM2.5 | 46.97μg/m3 | 1.27 (1.12, 1.43) | DM prevalence | Self-reported information using the following three criteria: 1) diagnosed with diabetes mellitus by a health care professional; 2) taking insulin or other medical treatments to reduce blood glucose levels during the last 12 months before the survey; 3) consuming a special diet and physical exercise regimen related to diabetes as recommended by medical professionals |
Zhang Q, et al (2021)[ | Cross-sectional | 150 counties or districts from 28 provinces, China | 13,013 | 2011 - 2012 | NO2 | 24μg/m3 | 1.13 (1.01, 1.26) | DM prevalence | Primary definition of diabetes meeting at least one of the following criteria: FBG >126 mg/dl, a non-FBG >200 mg/dl, HbA1c > 6.5%, or using antidiabetic medications; self-reported diabetes defined as answering “Yes” to the question “Have you been diagnosed with diabetes or high blood sugar?” |
"
Study and year | Selection | Comparability | Exposure | Score | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|
1 | 2 | 3 | 4 | 1 | 1 | 2 | 3 | ||||
Cross-sectional studies | |||||||||||
Hassanvand MS, et al. (2017) | * | * | * | * | * | * | 6 | ||||
Jacob AM, et al. (2019) | * | * | * | * | * | 5 | |||||
Liu C, et al. (2016) | * | * | * | * | ** | * | * | 8 | |||
Suryadhi MAH, et al. (2020) | * | * | * | * | ** | * | * | 7 | |||
Wang M, et al. (2020) | * | * | * | * | ** | * | * | 8 | |||
Yang BY, et al. (2018) | * | * | * | * | ** | * | * | * | 9 | ||
Yang Y, et al. (2018) | * | * | * | * | ** | * | 7 | ||||
Zhang Q, et al. (2021) | * | * | * | * | ** | * | * | 8 | |||
Cohort Studies | |||||||||||
Bo Y, et al. (2021) | * | * | * | ** | ** | * | * | 9 | |||
Chilian-Herrera OL, et al. (2021) | * | * | * | ** | * | * | 7 | ||||
Jabbari F, et al. (2020) | * | * | * | * | ** | * | * | 8 | |||
Liu F, et al. (2019) | * | * | * | * | ** | * | * | 8 | |||
Li CY, et al. (2019) | * | * | * | ** | * | * | * | 8 | |||
Li YL, et al. (2021) | * | * | * | ** | * | * | * | 8 | |||
Qiu H, et al. (2018) | * | * | * | * | ** | ** | * | * | 10 | ||
Shan A, et al. (2020) | * | * | * | ** | * | * | * | 8 |
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