Green space and its types can attenuate the associations of PM 2.5 and its components with prediabetes and diabetes-- a multicenter cross-sectional study from eastern China

The effect of fine particulate matter (PM ) components on prediabetes and diabetes is of concern, but the evidence is limited and the specific role of different green space types remains unclear. This study aims to investigate the relationship of PM and its components with prediabetes and diabetes as well as the potential health benefits of different types and combinations of green spaces. A multicenter cross-sectional study was conducted in eastern China by using a multi-stage random sampling method. Health screening and questionnaires for 98,091 participants were performed during 2017-2020. PM and its five components were estimated by the inverse distance weighted method, and green space was reflected by the Normalized Difference Vegetation Index (NDVI), percentages of tree or grass cover. Multivariate logistic regression and quantile g-computing were used to explore the associations of PM and five components with prediabetes and diabetes and to elucidate the potential moderating role of green space and corresponding type combinations in these associations. Each interquartile range (IQR) increment of PM was associated with both prediabetes (odds ratio [OR]: 1.15, 95%CI [confidence interval]: 1.10-1.20) and diabetes (OR: 1.18, 95% CI: 1.11-1.25), respectively. All five components of PM were related to prediabetes and diabetes. The ORs of PM on diabetes were 1.49 (1.35-1.63) in the low tree group and 0.90 (0.82-0.98) in the high tree group, respectively. In the high tree-high grass group, the harmful impacts of PM and five components were significantly lower than in the other groups. Our study suggested that PM and its components were associated with the increased risk of prediabetes and diabetes, which could be diminished by green space. Furthermore, the coexistence of high levels of tree and grass cover provided greater benefits. These findings had critical implications for diabetes prevention and green space-based planning for healthy city.