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• Extreme cold was significantly associated with diabetes in winter and March. • The increased diabetes risks were more consistent in March than in the winter. • Cases with hyperglycemia and peripheral artery complications were more susceptible. • Synergistic interactions were found between cold and UFP on diabetes admissions. • Cold-diabetes associations varied by age, sex, urbanicity, and comorbidities. Although the associations between ambient heat and diabetes have been assessed, the odds of ambient extreme cold exposure (ECE) or ultrafine particles (UFP) on diabetes admissions are understudied. We assessed the impacts of ECE on diabetes hospitalization and evaluated the modifications of demographics, comorbidities, and UFP on ECEdiabetes associations. A time-stratified case-crossover study was conducted by using mandatory New York State (NYS) admission data (principal diagnosis, 2013-2020) and temperature and simulated UPF data from NYS Mesonet and a global chemistry transport model, respectively. We defined ECE as 50th percentile of the daily mean UFP. After adjusting for air pollutants, humidity, and holidays, we conducted conditional logistic regressions to investigate ECE-diabetes associations, additive and multiplicative interactions between UFP, demographics/comorbidities, and ECE. Diabetes admissions associated with ECE were significantly elevated in winter months (ranges of odds ratios (ORs): 1.099-1.104, P0 for the attributable proportion to interactions and relative excess risk index) and multiplicative (P<0.05 for product terms) scales. Furthermore, females, older adults, urban residents, and patients with multiple comorbidities were more vulnerable to ECE than other groups. ECE-diabetes associations were significant in winter months, but the increased associations occurred more persistently in March. While synergistic and additive interactions between ECE and UFP on diabetes were found, ECE-diabetes ssociations were also modified by demographics and comorbidities.
Gao et al. (Tue,) studied this question.