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  • Interactions between long-term ambient particle exposures and lifestyle on the prevalence of hypertension and diabetes: insight from a large community-based survey

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Original research
Interactions between long-term ambient particle exposures and lifestyle on the prevalence of hypertension and diabetes: insight from a large community-based survey
  1. Huanle Cai1,
  2. Zhicheng Du1,
  3. Xiao Lin1,
  4. Wayne R Lawrence2,
  5. Philip K Hopke3,4,
  6. David Q Rich4,
  7. Shao Lin5,
  8. Jianpeng Xiao6,
  9. Xinlei Deng5,
  10. Yanji Qu7,
  11. Ziqiang Lin8,
  12. Xinran Wang1,
  13. Xu Ju1,
  14. Shirui Chen1,
  15. Yuqin Zhang1,
  16. Wenjing Wu1,
  17. Ying Wang1,
  18. Jing Gu1,
  19. Yuantao Hao9,
  20. Wangjian Zhang1
  1. 1 School of Public Health/Sun Yat-sen Global Health Institute/Center for Health Information Research, Sun Yat-Sen University, Guangzhou, Guangdong, China
  2. 2 Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
  3. 3 Institute for a Sustainable Environment, Clarkson University, Potsdam, New York, USA
  4. 4 Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
  5. 5 Department of Environmental Health Sciences, University at Albany, State University of New York, Rensselaer, New York, USA
  6. 6 Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong, China
  7. 7 Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangzhou, Guangdong, China
  8. 8 Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong, China
  9. 9 Peking University Center for Public Health and Epidemic Preparedness & Response, Peking University, Beijing, China
  1. Correspondence to Professor Wangjian Zhang, Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, Guangdong, China; zhangwj227{at}mail.sysu.edu.cn; Professor Yuantao Hao, Peking University Center for Public Health and Epidemic Preparedness & Response, Peking University, Beijing, China; haoyt{at}bjmu.edu.cn

Abstract

Introduction Evidence on the interaction of lifestyle and long-term ambient particle (PM) exposure on the prevalence of hypertension, diabetes, particularly their combined condition is limited. We investigate the associations between PM and these outcomes and whether the associations were modified by various lifestyles.

Methods This was a large population-based survey during 2019–2021 in Southern China. The concentrations of PM were interpolated and assigned to participants by the residential address. Hypertension and diabetes status were from questionnaires and confirmed with the community health centres. Logistic regression was applied to examine the associations, followed by a comprehensive set of stratified analyses by the lifestyles including diet, smoking, drinking, sleeping and exercise.

Results A total of 82 345 residents were included in the final analyses. For each 1 μg/m3 increase in PM2.5, the adjusted OR for the prevalence of hypertension, diabetes and their combined condition were 1.05 (95% CI 1.05 to 1.06), 1.07 (95% CI 1.06 to 1.08) and 1.05 (95% CI 1.04 to 1.06), respectively. We observed that the association between PM2.5 and the combined condition was greatest in the group with 4–8 unhealthy lifestyles (OR=1.09, 95% CI 1.06 to 1.13) followed by the group with 2–3 and those with 0–1 unhealthy lifestyle (P interaction=0.026). Similar results and trends were observed in PM10 and/or in those with hypertension or diabetes. Individuals who consumed alcohol, had inadequate sleep duration or had poor quality sleep were more vulnerable.

Conclusion Long-term PM exposure was associated with increased prevalence of hypertension, diabetes and their combined condition, and those with unhealthy lifestyles suffered greater risks of these conditions.

  • air pollution
  • environmental health
  • health impact assessment
  • hypertension
  • diabetes mellitus

Data availability statement

Data are available on reasonable request. The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

https://doi.org/10.1136/jech-2023-220480

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    Data availability statement

    Data are available on reasonable request. The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

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    Footnotes

    • Twitter @waynerlawrence

    • HC, ZD and XL contributed equally.

    • Contributors HC: conceptualisation, methodology, software, validation, formal analysis, data curation, writing—original draft, writing–review and editing, visualisation. ZD: conceptualisation, methodology, validation, investigation, data curation, writing—review and editing. XL: conceptualisation, validation, investigation, data curation, writing—review and editing, funding acquisition. WRL, PKH, DQR, SL, JX, XD, YQ, ZL: writing—review and editing. XW, XJ: conceptualisation, methodology, software, validation, data curation. SC, YZ, WW, YW, JG: conceptualisation, writing—review and editing. YH, WZ: conceptualisation, validation, Investigation, formal analysis, data curation, writing—review and editing, funding acquisition, resources, supervision, project administration. YH and WZ are responsible for the overall content as guarantors. All authors read and approved the final manuscript.

    • Funding This work was supported by the National Natural Science Foundation of China (grant number 2018ZX10715004, 82204154 and 82204162), the Natural Science Foundation of Guangdong Province (grant number 2022A1515010823), the Guangdong Basic and Applied Basic Research Foundation (grant number 2020A1515110230 and 2021A1515011765), the Guangzhou Basic and Applied Basic Research Foundation (grant number 2023A04J2072) and the China Postdoctoral Science Foundation (grant number 2021M693594).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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