Exploring the link between particulate matter pollution and type II Diabetes in Italy and Lombardy using clinical longitudinal data: a comparative analysis

Background: The association between particulate ambient air pollution and an increased risk of type II Diabetes (T2DM) is well-established. Air pollution, a significant public health concern globally, affects various non-communicable diseases, including T2DM. Italy faces significant challenges with both particulate air pollution and T2DM. No studies in Italy exist assessing the association of particulate and T2DM on a large dataset regarding clinically diagnosed T2DM. Methods: This study aims to assess the association between particulate matter (PM2.5 and PM10) and T2DM prevalence, and incidence rate in Lombardy compared to the rest of Italy from 2006 to 2019. The association with Years lived with disability (YLDs) rates has been assessed on data from 2006 to 2016. Data is obtained from the AMD dataset, a comprehensive outpatient longitudinal dataset, while particulate matter data is sourced from European Environment Agency and ARPA Lombardy. The association has been assessed via mixed-effects models. Results: The mixed-effects model revealed a significant positive association between particulate matter and T2DM incidence rates in Italy, with notable variations over time and between regions (Lombardy vs the rest of Italy). While no significant effect was observed of particulate on prevalence rates and YLDs rates, there is a positive significant connection between particulate and Incidence rate for Italy. The effect increases with time. The opposite tendency has been observed for Lombardy with a negative association of particulate and incidence. Said effect decreases with time opposing the trend for Italy. Conclusions: Particulate matter pollution, specifically PM2.5 and PM10, seems to be significantly associated with T2DM incidence rates in Italy. However, the impact varies between regions, with Lombardy exhibiting a complex relationship influenced by socioeconomic factors. This study underscores the importance of addressing air pollution as a public health priority, particularly in regions with high pollution levels like Lombardy, to mitigate the risk of T2DM and its associated burden.