摘要：Background Physical activity (PA), especially outdoor PA, may have twofold effects on diabetes risk: the health benefits of PA and the potential detrimental effects caused by augmented exposure to air pollution. We examined the association of combined effects of PA and air pollution with diabetes in older adults. Methods The study participants consisted of 1,259,871 older adults aged 58 years or more from the Korean National Health Insurance Service database. The exposure to air pollution was estimated by the average ambient levels of particulate matter (PM) of the participants’ residence area. Cox proportional hazards models were used to evaluate the adjusted hazard ratios and 95% confidence intervals of developing diabetes according to the combined effect of moderate to vigorous physical activity (MVPA) and air pollution exposure. Results Engaging in 5 or more times of MVPA/week was associated with decreased risk of diabetes within groups with both high and low/moderate levels of exposure to PM10 (low/moderate PM10 aHR 0.91, 95% CI 0.89–0.93; high PM10 aHR 0.97, 95% CI 0.94–0.99) or PM2.5 (low/moderate PM2.5 aHR 0.88, 95% CI 0.85–0.90; high PM10 aHR 0.95, 95% CI 0.91–0.99) exposure. The risk-reducing effects upon MVPA tended to be slightly attenuated, which showed the reverse J-shaped association, but still significant, among those who were exposed to a high level of air pollution. The association was consistent among stratified analyses according to the possible confounders. Conclusion MVPA may be inversely associated with the risk of diabetes development within groups with both high and low/moderate levels of exposure to PM10 or PM2.5 in older adults. Future studies are necessary to validate whether the positive health effects of MVPA outweigh the potential detrimental effects due to augmented exposure to air pollution during MVPA.
关键词：Air pollution ; Particulate matter ; Physical activity ; Diabetes ; Older adults ; Epidemiology ; PA physical activity ; MVPA moderate to vigorous physical activity ; SDG Sustainable Development Goal ; NCD Noncommunicable diseases ; HR hazard ratio ; CI confidence interval ; SD standard deviation ; PM particulate matter ; NHIS National Health Insurance Service ; IRB Institutional Review Board ; NAMIS National Ambient air Monitoring System ; ICD International Classification of Diseases ; ADA American Diabetes Association ; PAG Physical Activity Guidelines for Americans ; BMI body mass index ; CCI Charlson comorbidity index ; GIS geographic information systems
