Introduction: Arsenic, beryllium, cadmium and nickel have been associated with the prevalence of diabetes mellitus in populations exposed to these elements. However, diabetes mortality has not been evaluated. This eco...Introduction: Arsenic, beryllium, cadmium and nickel have been associated with the prevalence of diabetes mellitus in populations exposed to these elements. However, diabetes mortality has not been evaluated. This ecological study correlated airborne concentrations of these metals with diabetes mortality in North Carolina counties. Methods: County level data were extracted from the 2000 US Census, the 1999 US Environmental Protection Agency National Air Toxins Assessment, and 2001-2005 diabetes mortality rates by county from the North Carolina State Center for Health Statistics. Multivariable linear regression correlated airborne concentrations of each element with diabetes mellitus mortality rates in all 100 North Carolina counties controlling for county-level characteristics. Airborne concentrations were logarithmically transformed to normalize their distribution. Results: The lowest air concentrations detected were beryllium and cadmium, with nickel showing the highest concentration. Logarithmic concentrations spanned from 3.74 to 4.02 orders of magnitude. County-level diabetes mortality rates were negatively associated with median county income, but positively associated with county-level air concentrations of arsenic, beryllium, cadmium and nickel. Conclusions: These results support diabetes mortality effects of air pollution, and agree with other studies correlating arsenic, beryllium, cadmium and nickel with diabetes prevalence. Policy implications include regulating point source air pollution.展开更多
Worldwide, over 250 million people live with diabetes mellitus, a disease which has been described as an epidemic. While much is known about the cardiovascular risks associated with this condition, its association wit...Worldwide, over 250 million people live with diabetes mellitus, a disease which has been described as an epidemic. While much is known about the cardiovascular risks associated with this condition, its association with cancer has been less appreciated at the population level. This study assessed the relationship between colo-rectal, breast and prostate cancer mortality, and diabetes prevalence measured years earlier at the county level in the 100 counties of North Carolina. Methods: County level data were obtained from the 2000 US Census, the Centers for Disease Control and Prevention, and the North Carolina State Center for Health Statistics. The 2004 diabetes prevalence data by county and county level mortality from 2005 to 2009 for colorectal, breast and prostate cancer mortality were analyzed descriptively. Then multivariate linear regression was carried out to evaluate the contribution of pre-existing diabetes prevalence to cancer mortality, controlling county level covariates. Results: Average North Carolina county level prevalence of diabetes mellitus in 2004 (9%) was higher than the average prevalence of diabetes nationally in 2004 (7%). Mortality rates for breast, colorectal and prostate cancers at the county level were also higher than those nationally. In multivariate analysis, county level 2005-2009 total cancer mortality as well as mortality from colon and prostate cancers (but not breast cancer) correlated with county level 2004 diabetes prevalence rates. Diabetes mellitus prevalence in 2004 explained 31%, 34% and 42% of the variance of mortality from prostate, colorectal and total cancers. Conclusions: These findings support the relationship between diabetes mellitus and cancer at the population level. Direct and indirect costs of cancer care in North Carolina in 2004 were $5.57 billion. Because diabetes explained 42% of the variance of total county level cancer mortality, prevention and control of diabetes could save the state over $2 billion.展开更多
文摘Introduction: Arsenic, beryllium, cadmium and nickel have been associated with the prevalence of diabetes mellitus in populations exposed to these elements. However, diabetes mortality has not been evaluated. This ecological study correlated airborne concentrations of these metals with diabetes mortality in North Carolina counties. Methods: County level data were extracted from the 2000 US Census, the 1999 US Environmental Protection Agency National Air Toxins Assessment, and 2001-2005 diabetes mortality rates by county from the North Carolina State Center for Health Statistics. Multivariable linear regression correlated airborne concentrations of each element with diabetes mellitus mortality rates in all 100 North Carolina counties controlling for county-level characteristics. Airborne concentrations were logarithmically transformed to normalize their distribution. Results: The lowest air concentrations detected were beryllium and cadmium, with nickel showing the highest concentration. Logarithmic concentrations spanned from 3.74 to 4.02 orders of magnitude. County-level diabetes mortality rates were negatively associated with median county income, but positively associated with county-level air concentrations of arsenic, beryllium, cadmium and nickel. Conclusions: These results support diabetes mortality effects of air pollution, and agree with other studies correlating arsenic, beryllium, cadmium and nickel with diabetes prevalence. Policy implications include regulating point source air pollution.
文摘Worldwide, over 250 million people live with diabetes mellitus, a disease which has been described as an epidemic. While much is known about the cardiovascular risks associated with this condition, its association with cancer has been less appreciated at the population level. This study assessed the relationship between colo-rectal, breast and prostate cancer mortality, and diabetes prevalence measured years earlier at the county level in the 100 counties of North Carolina. Methods: County level data were obtained from the 2000 US Census, the Centers for Disease Control and Prevention, and the North Carolina State Center for Health Statistics. The 2004 diabetes prevalence data by county and county level mortality from 2005 to 2009 for colorectal, breast and prostate cancer mortality were analyzed descriptively. Then multivariate linear regression was carried out to evaluate the contribution of pre-existing diabetes prevalence to cancer mortality, controlling county level covariates. Results: Average North Carolina county level prevalence of diabetes mellitus in 2004 (9%) was higher than the average prevalence of diabetes nationally in 2004 (7%). Mortality rates for breast, colorectal and prostate cancers at the county level were also higher than those nationally. In multivariate analysis, county level 2005-2009 total cancer mortality as well as mortality from colon and prostate cancers (but not breast cancer) correlated with county level 2004 diabetes prevalence rates. Diabetes mellitus prevalence in 2004 explained 31%, 34% and 42% of the variance of mortality from prostate, colorectal and total cancers. Conclusions: These findings support the relationship between diabetes mellitus and cancer at the population level. Direct and indirect costs of cancer care in North Carolina in 2004 were $5.57 billion. Because diabetes explained 42% of the variance of total county level cancer mortality, prevention and control of diabetes could save the state over $2 billion.
