Long-Term Exposure to Traffic-Related Air Pollution and Diabetes: A Systematic Review and Meta-Analysis

Meltem Kutlar Joss; Hanna Boogaard; Evangelia Samoli; Allison P Patton; Richard Atkinson; Jeff Brook; Howard Chang; Pascale Haddad; Gerard Hoek; Ron Kappeler; Sharon Sagiv; Audrey Smargiassi; Adam Szpiro; Danielle Vienneau; Jennifer Weuve; Fred Lurmann; Francesco Forastiere; Barbara H Hoffmann

doi:10.3389/ijph.2023.1605718

Long-Term Exposure to Traffic-Related Air Pollution and Diabetes: A Systematic Review and Meta-Analysis

Int J Public Health. 2023 May 31:68:1605718. doi: 10.3389/ijph.2023.1605718. eCollection 2023.

Authors

Meltem Kutlar Joss^{1

2

3}, Hanna Boogaard⁴, Evangelia Samoli⁵, Allison P Patton⁴, Richard Atkinson⁶, Jeff Brook⁷, Howard Chang⁸, Pascale Haddad³, Gerard Hoek⁹, Ron Kappeler^{1

2}, Sharon Sagiv¹⁰, Audrey Smargiassi¹¹, Adam Szpiro¹², Danielle Vienneau^{1

2}, Jennifer Weuve¹³, Fred Lurmann¹⁴, Francesco Forastiere¹⁵, Barbara H Hoffmann³

Affiliations

¹ Swiss Tropical and Public Health Institute, Allschwil, Switzerland.
² University of Basel, Basel, Switzerland.
³ Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany.
⁴ Health Effects Institute, Boston, MA, United States.
⁵ Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
⁶ Population Health Research Institute, St. George's University of London, London, United Kingdom.
⁷ Occupational and Environmental Health Division, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
⁸ Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia.
⁹ Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands.
¹⁰ Center for Environmental Research and Children's Health, Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA, United States.
¹¹ Department of Environmental and Occupational Health, School of Public Health, University of Montreal, Montreal, QC, Canada.
¹² Department of Biostatistics, University of Washington, Seattle, WA, United States.
¹³ Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States.
¹⁴ Sonoma Technology, Inc., Petaluma, CA, United States.
¹⁵ Faculty of Medicine, School of Public Health, Imperial College, London, United Kingdom.

Abstract

Objectives: We report results of a systematic review on the health effects of long-term traffic-related air pollution (TRAP) and diabetes in the adult population. Methods: An expert Panel appointed by the Health Effects Institute conducted this systematic review. We searched the PubMed and LUDOK databases for epidemiological studies from 1980 to July 2019. TRAP was defined based on a comprehensive protocol. Random-effects meta-analyses were performed. Confidence assessments were based on a modified Office for Health Assessment and Translation (OHAT) approach, complemented with a broader narrative synthesis. We extended our interpretation to include evidence published up to May 2022. Results: We considered 21 studies on diabetes. All meta-analytic estimates indicated higher diabetes risks with higher exposure. Exposure to NO₂ was associated with higher diabetes prevalence (RR 1.09; 95% CI: 1.02; 1.17 per 10 μg/m³), but less pronounced for diabetes incidence (RR 1.04; 95% CI: 0.96; 1.13 per 10 μg/m³). The overall confidence in the evidence was rated moderate, strengthened by the addition of 5 recently published studies. Conclusion: There was moderate evidence for an association of long-term TRAP exposure with diabetes.

Keywords: NO2; confidence assessment; diabetes; particulate matter; traffic-related air pollution.

Publication types

Meta-Analysis
Systematic Review
Review

MeSH terms

Adult
Air Pollutants* / adverse effects
Air Pollutants* / analysis
Air Pollution* / adverse effects
Air Pollution* / analysis
Diabetes Mellitus* / epidemiology
Diabetes Mellitus* / etiology
Environmental Exposure / adverse effects
Environmental Exposure / analysis
Humans
Incidence
Particulate Matter / analysis

Substances

Air Pollutants
Particulate Matter

Grants and funding

Research described in this article was conducted under contract to the HEI, an organization jointly funded by the United States Environmental Protection Agency (EPA) [Assistance Award No. CR-83998101] and certain motor vehicle and engine manufacturers. MKJ work is supported by the Swiss Federal Office for the Environment [Grant No. 17.0094.PJ/R192-0332] as part of its funding for the work of the LUDOK-database. The funders were not involved in the study design, collection, analysis, interpretation of data, the writing of this article or the decision to submit it for publication.