Abstract
BACKGROUND AND AIM: Increasing incidence of early-onset type 1 diabetes (T1D) has been reported worldwide. Evidence shows that environmental exposures contribute to developing pancreatic islet autoantibodies in individuals with predisposing genes. This study aimed to investigate the effect of environmental exposures and socioeconomic levels on childhood presymptomatic T1D incidence (defined as having at least 2 islet autoantibodies) in Bavaria, Germany. METHODS: Long-term exposure to air pollution (nitrogen dioxide (NO2), Ozone (O3) and particulate matter with a diameter 2.5 μm (PM2.5)) and ambient temperature as well as surrounding greenness and area-level socioeconomic status (SES) were assigned to the residential addresses of 52,636 children (6 years of age) participating in the Fr1da study from 2015 to 2019. Information on demographic characteristics was extracted from self-administered questionnaires. We applied generalized additive models to examine the association of environmental factors and SES with presymptomatic T1D incidence adjusting for sex, age and family history of diabetes. We inspected single as well as multi-exposure models. RESULTS:225 children were diagnosed with presymptomatic T1D. Higher age at the time of diagnosis and having family history of diabetes was related to developing presymptomatic T1D (p0.00). An interquartile range (IQR) increase in O3 was associated with significantly higher odds of developing presymptomatic T1D (IQR: 5.06, Odds ratio (OR): 1.26; 95% confidence interval (CI): 1.08-1.48). One IQR increase in ambient temperature had an inverse association (IQR: 0.92, OR: 0.78, 95% CI: 0.66-0.93). Multi-exposure models indicated similar results, though both effects estimates were slightly shifted to the null. Other exposures were not associated with presymptomatic T1D. CONCLUSIONS:Exposure to higher levels of O3 and low ambient temperature may predispose to T1D development in children. KEYWORDS: Air pollution, Long-term exposure, Ozone, Temperature, Green space, Socio-economic factors
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