Elsevier

Annals of Epidemiology

Volume 21, Issue 1, January 2011, Pages 42-47
Annals of Epidemiology

A Prospective Study Investigating the Association Between Environmental Tobacco Smoke Exposure and the Incidence of Type 2 Diabetes in Never Smokers

https://doi.org/10.1016/j.annepidem.2010.10.006Get rights and content

Purpose

We studied a cohort of individuals to assess whether intensity of environmental tobacco smoke (ETS) exposure is associated with the incidence of type 2 diabetes.

Methods

Study subjects were selected from an ongoing population-based cohort of Korea Genome and Epidemiology Study. Participants of the baseline study 10,038 persons within the age range of 40 to 69 years old. Among 4,442 never smokers without prevalent diabetes, 465 type 2 diabetes cases were identified through biennial active follow-ups for a 6-year period. Cox proportional hazard models were used to estimate the hazard ratio (HR) and 95% confidence intervals (CI) after adjustment for covariates.

Results

The risk of type 2 diabetes was higher in subjects exposed to ETS compared with the nonexposure group (HR = 1.41, 95% CI: 1.1–1.70). Daily exposure to ETS at home increased the risk of type 2 diabetes when compared with the risk level of nonexposure (HR = 1.46, 95% CI: 1.16–1.83). Over 4 hours exposure to ETS at home and in the workplace was associated with increased the risk of type 2 diabetes (HR = 1.96, 95% CI: 1.21–3.19).

Conclusions

Our study suggests that ETS exposure is a significant risk factor for the development of type 2 diabetes with dose-response relationship.

Introduction

Type 2 diabetes is one of the most prevalent chronic diseases in the world, and it is known to give rise to secondary complications such as cardiovascular disease, renal failure, and blindness. The prevalence of type 2 diabetes is expected to dramatically increase by the year 2025 (1), and therefore the identification of risk factors and prevention strategies for the disease are significant public health concerns.

Although active smoking has been considered a risk factor for type 2 diabetes 2, 3, 4, 5, 6, 7, the association between environmental tobacco smoke (ETS) exposure and the risk of developing type 2 diabetes has not been fully investigated. Only two prior studies have reported a significant association between ETS exposure and the development of glucose intolerance or type 2 diabetes 3, 8. In addition, these studies did not measure the intensity of ETS exposure and could not assess the dose-response relationship between ETS exposure and the risk of developing type 2 diabetes.

The aim of this study was to determine whether ETS exposure has a dose-response relationship with the incidence of type 2 diabetes in a Korean cohort.

Section snippets

Study Population and Data Collection

Study subjects were selected from an ongoing population-based cohort of Korea Genome and Epidemiology Study. Participants were recruited among the residents in a rural community (Ansung) and an urban community (Ansan). The base populations of each city from 40 to 69 years of age were 132,906 for Ansung and 554,998 for Ansan in the year of 2000. To select a represented sample of each community, in Ansung, 5 Myeons (governing region similar to township) were selected out of 11 Myeons by cluster

Results

In our study population, mean and median value of the follow-up period was 5.1 and 5.7 years, respectively. Among incident cases, percentage of persons who reported using hypoglycemic medication in the no ETS exposure and ETS exposure categories was 21% and 28%, respectively.

Table 1 illustrates the baseline characteristics of the study population according to ETS exposure. The prevalence of ETS exposure in never smokers was 41.4%. Subjects exposed to ETS tended to have higher HOMA-IR levels,

Discussion

In this population-based cohort study, we examined whether ETS exposure had a dose-response relationship with the incidence of type 2 diabetes and we found that ETS exposure was significantly associated with an increased incidence of type 2 diabetes in the Korean population. The frequency and duration of exposure to ETS at home and in the workplace was positively correlated with the risk of type 2 diabetes.

The harmful health effects of ETS exposure have received considerable attention in recent

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