Exposure andMortality FromDiabetes

OBJECTIVEdRecent studies suggest that chronic exposure to air pollution can promote the development of diabetes. However, whether this relationship actually translates into an increased risk of mortality attributable to diabetes is uncertain. RESEARCH DESIGN AND METHODSdWe evaluated the association between long-term exposure to ambient fine particulate matter (PM2.5) and diabetes-related mortality in a prospective cohort analysis of 2.1 million adults from the 1991 Canadian census mortality follow-up study. Mortality information, including;5,200 deaths coded as diabetes being the underlying cause, was ascertained by linkage to the Canadian Mortality Database from 1991 to 2001. Subject-level estimates of long-term exposure to PM2.5 were derived from satellite obser-vations. The hazard ratios (HRs) for diabetes-relatedmortality were related to PM2.5 and adjusted for individual-level and contextual variables using Cox proportional hazards survival models. RESULTSdMean PM2.5 exposure levels for the entire population were low (8.7 mg/m3; SD, 3.9 mg/m3; interquartile range, 6.2 mg/m3). In fully adjusted models, a 10-mg/m3 elevation in PM2.5 exposure was associatedwith an increase in risk for diabetes-relatedmortality (HR, 1.49; 95%CI, 1.37– 1.62). The monotonic change in risk to the population persisted to PM2.5 concentration,5 mg/