Lauren Pinault1, Michael Brauer2, Daniel L Crouse3, Scott Weichenthal4, Anders Erickson2, Aaron van Donkelaar5, Randall V Martin5,6, Shannon Charbonneau7, Perry Hystad8, Jeffrey R Brook9, Michael Tjepkema1, Tanya Christidis1, Richard Ménard10, Alain Robichaud10, Richard T Burnett11. 1. From the Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada. 2. University of British Columbia, Vancouver, British Columbia, Canada. 3. University of New Brunswick, Fredericton, New Brunswick, Canada. 4. McGill University, Montreal, Quebec, Canada. 5. Dalhousie University, Halifax, Nova Scotia, Canada. 6. Harvard-Smithsonian Center for Astrophysics, Cambridge, MA. 7. College of Family Physicians of Canada, Kingston, Ontario, Canada. 8. Oregon State University, Corvallis, OR. 9. University of Toronto, Toronto, Ontario, Canada. 10. Air Quality Research Division, Environment and Climate Change Canada, Dorval, Quebec, Canada. 11. Population Studies Division, Health Canada, Ottawa, Ontario, Canada.
Abstract
BACKGROUND: Diabetes is infrequently coded as the primary cause of death but may contribute to cardiovascular disease (CVD) mortality in response to fine particulate matter (PM2.5) exposure. We analyzed all contributing causes of death to examine susceptibility of diabetics to CVD mortality from long-term exposure. METHODS: We linked a subset of the 2001 Canadian Census Health and Environment Cohort (CanCHEC) with 10 years of follow-up to all causes of death listed on death certificates. We used survival models to examine the association between CVD deaths (n = 123,500) and exposure to PM2.5 among deaths that co-occurred with diabetes (n = 20,600) on the death certificate. More detailed information on behavioral covariates and diabetes status at baseline available in the Canadian Community Health Survey (CCHS)-mortality cohort (n = 12,400 CVD deaths, with 2,800 diabetes deaths) complemented the CanCHEC analysis. RESULTS: Among CanCHEC subjects, comention of diabetes on the death certificate increased the magnitude of association between CVD mortality and PM2.5 (HR = 1.51 [1.39-1.65] per 10 μg/m) versus all CVD deaths (HR = 1.25 [1.21-1.29]) or CVD deaths without diabetes (HR = 1.20 [1.16-1.25]). Among CCHS subjects, diabetics who used insulin or medication (included as proxies for severity) had higher HR estimates for CVD deaths from PM2.5 (HR = 1.51 [1.08-2.12]) relative to the CVD death estimate for all respondents (HR = 1.31 [1.16-1.47]). CONCLUSIONS: Mention of diabetes on the death certificate resulted in higher magnitude associations between PM2.5 and CVD mortality, specifically among those who manage their diabetes with insulin or medication. Analyses restricted to the primary cause of death likely underestimate the role of diabetes in air pollution-related mortality. See video abstract at, http://links.lww.com/EDE/B408.
BACKGROUND:Diabetes is infrequently coded as the primary cause of death but may contribute to cardiovascular disease (CVD) mortality in response to fine particulate matter (PM2.5) exposure. We analyzed all contributing causes of death to examine susceptibility of diabetics to CVD mortality from long-term exposure. METHODS: We linked a subset of the 2001 Canadian Census Health and Environment Cohort (CanCHEC) with 10 years of follow-up to all causes of death listed on death certificates. We used survival models to examine the association between CVD deaths (n = 123,500) and exposure to PM2.5 among deaths that co-occurred with diabetes (n = 20,600) on the death certificate. More detailed information on behavioral covariates and diabetes status at baseline available in the Canadian Community Health Survey (CCHS)-mortality cohort (n = 12,400 CVD deaths, with 2,800 diabetes deaths) complemented the CanCHEC analysis. RESULTS: Among CanCHEC subjects, comention of diabetes on the death certificate increased the magnitude of association between CVD mortality and PM2.5 (HR = 1.51 [1.39-1.65] per 10 μg/m) versus all CVD deaths (HR = 1.25 [1.21-1.29]) or CVD deaths without diabetes (HR = 1.20 [1.16-1.25]). Among CCHS subjects, diabetics who used insulin or medication (included as proxies for severity) had higher HR estimates for CVD deaths from PM2.5 (HR = 1.51 [1.08-2.12]) relative to the CVD death estimate for all respondents (HR = 1.31 [1.16-1.47]). CONCLUSIONS: Mention of diabetes on the death certificate resulted in higher magnitude associations between PM2.5 and CVD mortality, specifically among those who manage their diabetes with insulin or medication. Analyses restricted to the primary cause of death likely underestimate the role of diabetes in air pollution-related mortality. See video abstract at, http://links.lww.com/EDE/B408.
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Authors: Bo-Yi Yang; Yuming Guo; Iana Markevych; Zhengmin Min Qian; Michael S Bloom; Joachim Heinrich; Shyamali C Dharmage; Craig A Rolling; Savannah S Jordan; Mika Komppula; Ari Leskinen; Gayan Bowatte; Shanshan Li; Gongbo Chen; Kang-Kang Liu; Xiao-Wen Zeng; Li-Wen Hu; Guang-Hui Dong Journal: JAMA Netw Open Date: 2019-03-01