Association between environmental quality and diabetes in the U.S.A.

Caloric excess and physical inactivity fail to fully account for the rise of diabetes prevalence. Individual environmental pollutants can disrupt glucose homeostasis and promote metabolic dysfunction. However, the impact of cumulative exposures on diabetes risk is unknown. Materials and Methods The Environmental Quality Index, a county‐level index composed of five domains, was developed to capture the multifactorial ambient environmental exposures. The Environmental Quality Index was linked to county‐level annual age‐adjusted population‐based estimates of diabetes prevalence rates. Prevalence differences (PD, annual difference per 100,000 persons) and 95% confidence intervals (CI) were estimated using random intercept mixed effects linear regression models. Associations were assessed for overall environmental quality and domain‐specific indices, and all analyses were stratified by four rural‐urban strata. Results Comparing counties in the highest quintile/poorest environmental quality to those in the lowest quintile/best environmental quality, counties with poor environmental quality demonstrated lower total diabetes prevalence rates. Associations varied by rural–urban strata; overall better environmental quality was associated with lower total diabetes prevalence rates in the less urbanized and thinly populated strata. When considering all counties, good sociodemographic environments were associated with lower total diabetes prevalence rates (prevalence difference 2.77, 95% confidence interval 2.71–2.83), suggesting that counties with poor sociodemographic environments have an annual prevalence rate 2.77 per 100,000 persons higher than counties with good sociodemographic environments. Conclusions Increasing attention has focused on environmental exposures as contributors to diabetes pathogenesis, and the present findings suggest that comprehensive approaches to diabetes prevention must include interventions to improve environmental quality.

Impact/Purpose

This study addresses research questions under Sustainable and Healthy Communities (Project 2.64 Indicators, Indices & Report on the Environment and Project 2.62 Community Public Health & Well-Being). National Health Environmental Effects Research Laboratory in the Environmental Public Health Division, Epidemiology Branch is currently engaged in research aimed at developing a measure that estimates overall environmental quality at the county level across the U.S. spanning the years 2000 – 2005 called the Environmental Quality Index (EQI). This work is being conducted for the purpose of learning more about how various environmental factors contribute in concert to health disparities in low-income, underrepresented minority and vulnerable populations, and to better estimate the total environmental and social context to which humans are exposed. The EQI was used to assess associations between cumulative environmental exposures and diabetes in the U.S.

Citation

Jagai, J., A. Krajewski, S. Shaikh, D. Lobdell, AND R. Sargis. Association between environmental quality and diabetes in the U.S.A. John Wiley & Sons, Inc., Hoboken, NJ, 11(2):315-324, (2020). [DOI: 10.1111/jdi.13152]

DOI: Association between environmental quality and diabetes in the U.S.A.