Abstract

Background:

Air pollution contributes to type 2 diabetes and cardiovascular diseases, but its relevance for other complications of diabetes, in particular distal sensorimotor polyneuropathy (DSPN), is unclear. Recent studies have indicated that DSPN is also increasingly prevalent in obesity.

Objectives:

We aimed to assess associations of air pollutants with prevalent and incident DSPN in a population-based study of older individuals with high rates of type 2 diabetes and obesity.

Methods:

Cross-sectional analyses on prevalent DSPN were based on 1,075 individuals 62–81 years of age from the German Cooperative Health Research in the Region of Augsburg (KORA) F4 survey (2006–2008). Analyses on incident DSPN included 424 individuals without DSPN at baseline (KORA F4), of whom 188 had developed DSPN by the KORA FF4 survey (2013–2014). Associations of annual average air pollutant concentrations at participants’ residences with prevalent and incident DSPN were estimated using Poisson regression models with a robust error variance adjusting for multiple confounders.

Results:

Higher particle number concentrations (PNCs) were associated with higher prevalence [risk ratio (RR) per interquartile range (IQR) $\text{increase}=1.10$ (95% CI: 1.01, 1.20)] and incidence [1.11 (95% CI: 0.99, 1.24)] of DSPN. In subgroup analyses, particulate (PNC, ${\mathrm{PM}}_{10}$, ${\mathrm{PM}}_{\text{coarse}}$, ${\mathrm{PM}}_{2.5}$, and ${\mathrm{PM}}_{2.5\text{abs}}$) and gaseous (${\mathrm{NO}}_{\mathrm{x}}$, ${\mathrm{NO}}_2$) pollutants were positively associated with prevalent DSPN in obese participants, whereas corresponding estimates for nonobese participants were close to the null [e.g., for an IQR increase in PNC, $\text{RR}=1.17$ (95% CI: 1.05, 1.31) vs. 1.06 (95% CI: 0.95, 1.19); $p_{\text{interaction}}=0.22$]. With the exception of ${\mathrm{PM}}_{2.5\text{abs}}$, corresponding associations with incident DSPN were positive in obese participants but null or inverse for nonobese participants, with $p_{\text{interaction}}\le 0.13$ [e.g., for PNC, $\text{RR}=1.28$ (95% CI: 1.08, 1.51) vs. 1.03 (95% CI: 0.90, 1.18); $p_{\text{interaction}}=0.03$].

Discussion:

Both particulate and gaseous air pollutants were positively associated with prevalent and incident DSPN in obese individuals. Obesity and air pollution may have synergistic effects on the development of DSPN. https://doi.org/10.1289/EHP7311

中文翻译：

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长期空气污染与远端感觉运动性多发性神经病的患病率和发生率的关联：KORA F4 / FF4研究

摘要

背景：

空气污染会导致2型糖尿病和心血管疾病，但尚不清楚其与糖尿病其他并发症（尤其是远端感觉运动性多发性神经病（DSPN））的相关性。最近的研究表明，DSPN在肥胖症中也越来越普遍。

目标：

我们的目标是在针对人群中患有2型糖尿病和肥胖症的高龄人群的一项基于人群的研究中，评估空气污染物与普遍的和事件性DSPN的关联。

方法：

对流行的DSPN进行的横断面分析基于奥格斯堡地区德国合作卫生研究（KORA）F4调查（2006-2008年）中62-81岁的1,075个人。对DSPN事件的分析包括424名基线时没有DSPN的个体（KORA F4），其中188名通过KORA FF4调查（2013-2014）开发了DSPN。使用Poisson回归模型估算参与者住所的年平均空气污染物浓度与流行的DSPN和入射的DSPN的关联，该模型具有针对多个混杂因素的稳健的误差方差调整。

结果：

较高的颗粒数浓度（PNCs）与较高的患病率[每四分位间距（IQR）的患病率[RR] $\text{增加}=1.10$（95％CI：1.01，1.20）]和DSPN的发生率[1.11（95％CI：0.99，1.24）]。在亚组分析中，微粒（PNC，${\mathrm{下午}}_{10}$， ${\mathrm{下午}}_{\text{粗}}$， ${\mathrm{下午}}_{2.5}$和 ${\mathrm{下午}}_{2.5\text{腹肌}}$）和气态（${\mathrm{没有}}_{\mathrm{X}}$， ${\mathrm{没有}}_2$）污染物与肥胖参与者中普遍存在的DSPN呈正相关，而非肥胖参与者的相应估算值接近于零（例如，PNC的IQR增加， $\text{RR}=1.17$ （95％CI：0.95，1.19）（95％CI：1.05，1.31）； $p_{\text{相互作用}}=0.22$]。除了${\mathrm{下午}}_{2.5\text{腹肌}}$，与肥胖者的DSPN事件相关性为阳性，而非肥胖者为零或相反。 $p_{\text{相互作用}}\le 0.13$ [例如，对于PNC， $\text{RR}=1.28$ （95％CI：0.90，1.18）（95％CI：1.08，1.51）； $p_{\text{相互作用}}=0.03$]。

讨论：

肥胖个体中的颗粒物和气态空气污染物均与普遍的和事件性的DSPN正相关。肥胖和空气污染可能对DSPN的发展产生协同作用。https://doi.org/10.1289/EHP7311