Work

Residential proximity to chemical plants and the risk of diabetic microvascular complications independent of air pollution: a prospective cohort study

Year: 2026

Type: article

Abstract: Most evidence linking environmental exposures to diabetic microvascular complications (DMCs) has focused on routinely monitored ambient air pollutants. Chemical plants, by contrast, are fixed industrial point sources with heterogeneous, source-specific releases to air, land, and water that may not be fully captured by conventional environmental monitoring. Residential proximity can provide a spatial indicator of potential industrial-source exposure. Because source-related environmental influences may vary nonlinearly with distance through dispersion, dilution, and deposition, we examined whether residential proximity to chemical plants (RPCP) was associated with incident DMCs among individuals with type 2 diabetes mellitus (T2DM) after accounting for measured conventional ambient pollution and characterized the continuous distance–risk pattern. We analyzed 9,963 UK Biobank participants with T2DM and no DMCs at baseline. Residential distance to the nearest chemical plants was calculated. Incident DMCs—including diabetic retinopathy (DR), diabetic kidney disease (DKD), and diabetic neuropathy (DN)—were identified through linked health records. Cox proportional hazards models evaluated RPCP in categorical form and per 1-standard deviation decrease in distance, with sequential adjustment for covariates. Restricted cubic spline models characterized the distance–risk relationship. Spatial mapping and Ripley’s cross-type K-function analyses assessed spatial clustering. Sensitivity analyses examined alternative spline knots, geographic regions, local plant density, and manufacturing type. Over a median follow-up of 13.6 years, 1,883 incident DMCs occurred. Compared with participants residing ≥ 20 km from the nearest plant, those residing < 10 km had higher risks of overall DMCs (HR, 1.20; 95% CI, 1.10–1.31), DR (HR, 1.27; 95% CI, 1.10–1.46), DKD (HR, 1.23; 95% CI, 1.06–1.42), and DN (HR, 1.33; 95% CI, 1.03–1.72). Each 1-standard deviation decrease in distance was associated with a higher risk of overall DMCs (HR, 1.07; 95% CI, 1.01–1.13). Spline analyses showed that the excess risk attenuated toward the null at approximately 18 km in this cohort, with estimated intersections of 17.5–18.0 km across alternative knot specifications. Regional and plant-density analyses showed broadly directionally consistent associations. No evidence of residential clustering or spatial bias was observed. Closer residential proximity to chemical plants was associated with higher risks of DMCs after adjustment for measured conventional ambient pollutants and other potential confounders.

Source: BMC Public Health

DOI: 10.1186/s12889-026-29227-7

Authors: Xixuan Zhao, Juzhao Zhang, Yingyan Ma, Haidong Zou

Institutions: Tongji University, Shanghai Jiao Tong University, Shanghai Eye Disease Prevention & Treatment Center, Shanghai First People's Hospital

Language: English

Topic: Air Quality and Health Impacts

Subfield: Health, Toxicology and Mutagenesis

Field: Environmental Science

Domain: Physical Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,290