Insulin resistance and its relationship with long-term exposure to ozone: Data based on a national population cohort

The relationship of ozone (O₃), particularly the long-term exposure, with impacting metabolic homeostasis in population was understudied and under-recognised. Here, we used data from ChinaHEART, a nationwide, population-based cohort study, combined with O₃ and PM_2.5 concentration data with high spatiotemporal resolution, to explore the independent association of exposure to O₃ with the prevalence of insulin resistance (IR). Among the 271 540 participants included, the crude prevalence of IR was 39.1%, while the age and sex standardized prevalence stood at 33.0%. Higher IR prevalence was observed with each increase of 10.0 μg/m³ in long-term O₃ exposure, yielding adjusted odds ratios (OR) of 1.084 (95% CI: 1.079–1.089) in the one-pollutant model and 1.073 (95% CI: 1.067–1.079) in the two-pollutant model. Notably, a significant additive interaction between O₃ and PM_2.5 on the prevalence of IR was observed (P for additive interaction < 0.001). Our main findings remained consistent and robust in the sensitivity analyses. Our study suggests long-term exposure to O₃ was independently and positively associated with prevalence of IR. It emphasized the benefits of policy interventions to reduce O₃ and PM_2.5 exposure jointly, which could ultimately alleviate the health and economic burden related to DM.