The Short‐Term Effects and Burden of Ambient Air Pollution on Hospitalization for Type 2 Diabetes: Time‐Stratified Case‐Crossover Evidence From Sichuan, China.

Type 2 diabetes mellitus (T2DM), a complicated metabolic disease, might be developed or exacerbated by air pollution, resulting in economic and health burden to patients. So far, limited studies have estimated associations between short‐term exposure to air pollution and disease burden of T2DM in China. Hence, we aimed to estimate the associations and burden of ambient air pollutants (NO2, PM10, PM2.5, SO2, and CO) on hospital admissions (HAs) for T2DM using a time‐stratified case‐crossover design. Data on HAs for T2DM during 2017–2019 were collected from hospital electronic health records in nine cities in Sichuan Province using conditional poisson regression. Totally, 92,381 T2DM hospitalizations were recorded. There were significant short‐term effects of NO2, PM10, PM2.5, SO2 and CO on HAs for T2DM. A 10 μg/m3 increment of NO2, PM10, PM2.5, SO2 and CO as linked with a 3.39% (95% CI: 2.26%, 4.54%), 0.33% (95% CI: 0.04%, 0.62%), 0.76% (95% CI: 0.35%, 1.16%), 12.68% (95% CI: 8.14%, 17.42%) and 79.00% (95% CI: 39.81%, 129.18%) increase in HAs for T2DM at lag 6. Stratified analyses modified by age, sex, and season showed old (≥65 years) and female patients linked with higher impacts. Using WHO's air quality guidelines of NO2, PM10, PM2.5, and CO as the reference, the attributable number of T2DM HAs exceeding these pollutants exposures were 786, 323, 793, and 2,127 during 2017–2019. Besides, the total medical costs of 25.83, 10.54, 30.74, and 67.78 million China Yuan were attributed to NO2, PM10, PM2.5, and CO. In conclusion, short‐term exposures to air pollutants were associated with higher risks of HAs for T2DM. Plain Language Summary: Type 2 diabetes mellitus (T2DM) as complicated and severe metabolic disease, would be affected by air pollution, rendering numerous burdens on patients and society. In this study, the associations and burden of air pollutants (NO2, PM10, PM2.5, SO2, and CO) on hospital admissions (HAs) for T2DM were estimated using conditional poisson regression. Data on HAs for T2DM in nine cities in Sichuan Province during 2017–2019 were involved. In summary, there were 92,381 cases of T2DM hospitalizations. Results showed that significant short‐term effects of air pollution on HAs for T2DM. In stratified analyses modified by age, sex, and season, higher impacts were linked with old (≥65 years) and female patients. When adopting WHO's air guidelines of NO2, PM10, PM2.5, and CO, the attributable number and cost of HAs for T2DM exceeding air guidelines were estimated, posing central risks to public health. Continuous and further efforts should be taken to air pollution. Key Point: The short‐term effect of air pollution and disease burden of type 2 diabetes mellitus were estimated in Sichuan, China [ABSTRACT FROM AUTHOR]