Tuesday, October 25, 2016

Air Pollution, Diabetes & Promise Clinic Patients

A recent study published by Kathrin Wolf, Anita Popp, Alexandra Schneider et al. in October 2016's issue of Diabetes  suggested "an association between long-term exposure to air pollution and [insulin resistance] in the general population mainly attributable to pre-diabetic individuals." The German researchers controlled for sex, smoking status, BMI, socioeconomic status and relative amount of environmental exposure and found that "for each 7.9 microgram per cubic meter increase in soot and other particulate matter, there was a 15 percent higher rate of insulin resistance, a marker of Type 2 diabetes." This correlation was especially strong in people who were understood to be insulin resistant.

While the study only assesses correlation, it exists within a long-line of research that points at health disparities specific to people living in urban areas. This is especially true of people with low income, who tend to be more exposed to environmental toxins, noise and air pollution. They tend to have lower access to healthy foods, infrastructure that promotes exercise and active living, and healthcare facilities that can adequately accommodate urban need. All of these factors add up to increase rates in chronic disease-- including diabetes.

Wolf et al's research does more than add insult to injury of health inequity, however, because the authors do mention that, "The effect of air pollution can be countered with healthy diet and exercise." Obviously this is difficult, though, without the proper structures in place.

For this to be relevant to Promise Clinic and its patients means establishing two things: 1) That New Brunswick is Urban and 2) that this community experiences at least some measurable amounts of air pollution.

Comparing New Brunswick to its urban siblings of Philadelphia and New York might make one think that it couldn't possibly be classified as succumbing to the similar health outcomes. Bigger doesn't always mean badder, however-- especially when it comes to pollution. In theory, though, will be a more significant issue in New York, or even Newark than it is here. However, it is a city of 57,000 people and should be understood as such.  New Brunswick is also majority Latina/o (at 49.9%), with an average of four people living in each household. Around 32% of its people live below the poverty line.

All of these factors point towards increased risk of chronic disease. As far as air pollution goes, it is not uncommon for our area to dive into a "Moderate" level of environmental contamination, which is enough to ask whether air pollution is playing a part in these disparities at all. Unfortunately, long-term data on averages is not easily accessible-- monitoring the website points to pollution being a problem, perhaps due to our neighbors to the North and Southwest.

Specific to Promise Clinic, we know we serve New Brunswick's most vulnerable. This means that our Student Doctors are already on the lookout for the all of these disparities and other social health measures that could afflict our patients. Because they are all experiencing some sort of housing instability, we would expect their environmental exposures to be even more severe-- to exacerbate their already present problems.

Knowing all of this, and understanding that there are many factors at play, it is worthwhile to note that Type II Diabetes was the third most treated illness at Promise Clinic within 2014-2015. The German study was accurate in controlling for all of these disparities. This, to me, suggests air pollution might be something we should consider as we speak and work with our patients. If it can be counteracted with healthy diet and exercise-- as the authors suggest-- it only emphasizes these as important health factors despite all the disparities that stand against them.

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