Abstract
BackgroundActive smoking has been linked to type 2 diabetes mellitus (T2DM) but only few recent studies have shown environmental tobacco smoke (ETS) to be associated with DM in never-smokers. We assessed the association between long term ETS exposure and DM, and explored effect modifications of this association in our sample.MethodsWe analysed 6392 participants of the Swiss study on air pollution and lung and heart diseases in adults (SAPALDIA). We used mixed logistic regression models to assess the cross-sectional association between ETS and DM. Selected variables were tested for effect modification and several sensitivity analyses were performed, mostly treating participants’ study area as a random effect.ResultsThe prevalence of DM and ETS in the sample was 5.5% and 47% respectively. There were 2779 never-smokers with 4% diabetes prevalence. Exposure to ETS increased risk of DM in never-smokers by 50% [95% confidence interval (CI): 1.00, 2.26], and we observed a positive dose–response relationship between ETS exposure level and DM in never-smokers. Associations were strengthened (more than three-folds) by older age and chronic obstructive pulmonary disease, and were stronger in post-menopausal, obese, hypertriglyceridaemic and physically inactive participants. Estimates of association were robust across all sensitivity analyses (including inverse probability weighting for participation bias and fixed-effect analysis for study area). ETS had no substantial associations in current and ex-smokers in our study.ConclusionsWe found a positive association between ETS exposure and DM in never smokers. Additional longitudinal studies involving biomarkers are needed to further explore underlying mechanisms and susceptibilities.Electronic supplementary materialThe online version of this article (doi:10.1186/1476-069X-13-74) contains supplementary material, which is available to authorized users.
Highlights
Diabetes contributes significantly to global disabilityadjusted life years lost
We found a positive association between environmental tobacco smoke (ETS) exposure and Diabetes mellitus (DM) in never smokers
In never-smokers, ETS exposure was higher in females, younger participants, and participants with lower educational level, lower neighbourhood socio-economic index and lower physical activity, lower
Summary
Diabetes contributes significantly to global disabilityadjusted life years lost. Type 2 diabetes mellitus (T2DM)comprises >90% of global diabetes and its age-adjusted prevalence and incidence are steadily increasing [1].Smoking has been established as a risk factor for incident T2DM [2]. There has been interest in the health effects of environmental tobacco smoke (ETS), which contains >4000 chemical compounds that partly overlap with compounds inhaled in active smoke [3]. Multiple chemical components of ETS occur in higher concentration in sidestream than inhaled cigarette smoke [3]. These compounds are generally inflammatory, causing blood vessel injuries and endothelial dysfunction [5,6]. Active smoking has been linked to type 2 diabetes mellitus (T2DM) but only few recent studies have shown environmental tobacco smoke (ETS) to be associated with DM in never-smokers. We assessed the association between long term ETS exposure and DM, and explored effect modifications of this association in our sample
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