Sjölund BM, Nordberg G, Wimo A, von Strauss E.

Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden. britt-marie.sjolund@ki.se

Abstract
OBJECTIVES: To describe differences in morbidity and functional status according to living area.

DESIGN: Community-based survey.

SETTING: A community-based prospective cohort, the Kungsholmen-Nordanstig Project.

PARTICIPANTS: Adults aged 75 and older living in an urban area of central Stockholm (n=1,222) and in the rural community of Nordanstig in northern Sweden (n=919).

MEASUREMENTS: Physicians clinically examined all participants using the same standardized protocols in both living areas; trained nurses directly assessed disability.

RESULTS: Cardiovascular disease was the most common disorder in both living areas (39.9% in the urban area and 45.2% in the rural area). There were great area differences in the prevalence of stroke (7.4% and 14.0%), diabetes mellitus 6.3% and 16.1%), and Parkinson’s disease (1.0% and 3.7%). It was more common to have two or more diseases than no diseases in the rural area than in the urban area (odds ratio=1.9, 95% confidence interval=1.4-2.4). Significant living area differences (urban vs rural) in population attributable risk (PAR) was found for disability due to stroke (5.6 vs 32.2), diabetes mellitus (1.2 vs 6.1), fractures (1.4 vs 10.7), and hearing impairment (8.7 vs 22.0).

CONCLUSION: Differences were found in disability, morbidity, and disease patterns according to living area. The rural elderly population was more disabled and had more diseases than the urban elderly population, despite being slightly younger than the urban cohort. There were significant area differences in the PAR of how specific chronic conditions influenced the risk of disability.

© 2010, Copyright the Authors. Journal compilation © 2010, The American Geriatrics Society.
PMID: 20929463 [PubMed - indexed for MEDLINE]

RESEARCH DESIGN AND METHODS: The relationship between PM2.5 levels and diagnosed diabetes prevalence in the U.S. was assessed by multivariate regression models at the county level using data obtained from both the Centers for Disease Control and Prevention (CDC) and U.S. Environmental Protection Agency (EPA) for years 2004 and 2005. Covariates including obesity rates, population density, ethnicity, income, education, and health insurance were collected from the U.S. Census Bureau and the CDC.

RESULTS: Diabetes prevalence increases with increasing PM2.5 concentrations, with a 1% increase in diabetes prevalence seen with a 10 ?g/m(3) increase in PM2.5 exposure (2004: ? = 0.77 [95% CI 0.39-1.25], P < 0.001; 2005: ? = 0.81 [0.48-1.07], P < 0.001). This finding was confirmed for each study year in both univariate and multivariate models. The relationship remained consistent and significant when different estimates of PM2.5 exposure were used. Even for counties within guidelines for EPA PM2.5 exposure limits, those with the highest exposure showed a >20% increase in diabetes prevalence compared with that for those with the lowest levels of PM2.5, an association that persisted after controlling for diabetes risk factors.

CONCLUSIONS: Our results suggest PM2.5 may contribute to increased diabetes prevalence in the adult U.S. population. These findings add to the growing evidence that air pollution is a risk factor for diabetes.

Diabetes Care. 2010 Oct;33(10):2196-201. Epub 2010 Jul 13.

Pearson JF, Bachireddy C, Shyamprasad S, Goldfine AB, Brownstein JS.
Children’s Hospital Informatics Program at the Harvard-MIT Division of Health Sciences and Technology, Boston, Massachusetts, USA.

Schack-Nielsen L, Michaelsen KF.

Københavns Universitet, Det Biovidenskabelige Fakultet for Fødevarer, Veterinaermedicin.

Ugeskr Laeger. 2007 Mar 12;169(11):989-93

Schack-Nielsen L, Larnkjaer A, Michaelsen KF.
Department of Human Nutrition, The Royal Veterinary and Agric University, Denmark.

Adv Exp Med Biol. 2005;569:16-23.