Association between long-term exposure to ambient air pollution and prevalence of diabetes mellitus among Malaysian adults

Background Malaysia has the highest rate of diabetes mellitus (DM) in the Southeast Asian region, and has ongoing air pollution and periodic haze exposure. Methods Diabetes data were derived from the Malaysian National Health and Morbidity Surveys conducted in 2006, 2011 and 2015. The air pollution data (NO x , NO 2 , SO 2 , O 3 and PM 10 ) were obtained from the Department of Environment Malaysia. Using multiple logistic and linear regression models, the association between long-term exposure to these pollutants and prevalence of diabetes among Malaysian adults was evaluated. Results The PM 10 concentration decreased from 2006 to 2014, followed by an increase in 2015. Levels of NO x decreased while O 3 increased annually. The air pollutant levels based on individual modelled air pollution exposure as measured by the nearest monitoring station were higher than the annual averages of the five pollutants present in the ambient air. The prevalence of overall diabetes increased from 11.4% in 2006 to 21.2% in 2015. The prevalence of known diabetes, underdiagnosed diabetes, overweight and obesity also increased over these years. There were significant positive effect estimates of known diabetes at 1.125 (95% CI, 1.042, 1.213) for PM 10 , 1.553 (95% CI, 1.328, 1.816) for O 3 , 1.271 (95% CI, 1.088, 1.486) for SO 2 , 1.124 (95% CI, 1.048, 1.207) for NO 2 , and 1.087 (95% CI, 1.024, 1.153) for NO x for NHMS 2006. The adjusted annual average levels of PM 10 [1.187 (95% CI, 1.088, 1.294)], O 3 [1.701 (95% CI, 1.387, 2.086)], NO 2 [1.120 (95% CI, 1.026, 1.222)] and NO x [1.110 (95% CI, 1.028, 1.199)] increased significantly from NHMS 2006 to NHMS 2011 for overall diabetes. This was followed by a significant decreasing trend from NHMS 2011 to 2015 [0.911 for NO 2 , and 0.910 for NO x ]. Conclusion The findings of this study suggest that long-term exposure to O 3 is an important associated factor of underdiagnosed DM risk in Malaysia. PM 10 , NO 2 and NO x may have mixed effect estimates towards the risk of DM, and their roles should be further investigated with other interaction models. Policy and intervention measures should be taken to reduce air pollution in Malaysia.