The Relationship between Persistent Organic Pollutants Exposure and Type 2 Diabetes among First Nations in Ontario and Manitoba, Canada: A Difference in Difference Analysis
Abstract
:1. Introduction
2. Methods
2.1. Manitoba and Ontario First Nations
2.2. Data Collection
2.3. Fish Sampling and Contaminants Analysis
2.4. Estimation of Fish, Dietary POPs (DDE, PCBs), and Long-Chain Omega-3 FA Intake
2.5. Statistical Analyses
3. Results
4. Discussion
5. Conclusions
Supplementary Materials
Acknowledgments
Author Contributions
Conflicts of Interest
Abbreviations
BMI | body mass index |
CI | confident interval |
DDE | dichlorodiphenyldichloroethylene |
DID | difference in difference method |
DHA | docosahexaenoic acid |
EPA | eicosapentaenoic acid |
FA | fatty acids |
FFQ | food frequency questionnaire |
FNFNES | First Nations Food Nutrition and Environment Study |
OR | odds ratio |
PCBs | polychlorinated biphenyls |
POPs | persistent organic pollutants |
SHL | Socio-health-lifestyle questionnaire |
T2D | type 2 diabetes |
References
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Variables | Ontario | Manitoba | ||||
---|---|---|---|---|---|---|
Total | Male | Female | Total | Male | Female | |
Sample size | 1426 | 533 | 893 | 706 | 229 | 477 |
Type 2 diabetes | 327 | 110 | 217 | 123 | 47 | 76 |
Type-2 diabetes weighted (%) | 24.4 | 23.5 | 24.6 | 22.0 | 26.0 | 20.0 |
Type-2 diabetes standardized (%) | 25.0 | 23.7 | 25.7 | 28.4 | 32.1 | 26.5 |
Age | 46.5 (15.8) | 47.3 (16.0) | 45.9 (15.6) | 42.3 (14.4) | 43.1 (14.3) | 42.0 (14.5) |
BMI (kg/m2) | 30.9 (5.9) | 30.4 (5.4) | 31.1(6.1) | 30.3 (6.4) | 29.0 (5.8) | 30.9 (6.6) |
Moderate to vigorous physical activity | 498 (34.9) | 241 (45.2) | 257 (28.8) | 189 (26.8) | 85 (37.1) | 104 (21.8) |
Smoking (%) | 723 (50.7) | 276 (51.8) | 447 (50.1) | 444 (62.9) | 136 (59.4) | 308 (64.6) |
Years of education | 11.1 (3.8) | 10.5 (3.5) | 11.5 (3.9) | 9.8 (2.5) | 9.6 (2.7) | 9.9 (2.4) |
Total energy (kcal/day) | 2042.1 (1026.8) | 2344.5 (1222.1) | 1861.6 (840.4) | 1979.0 (1056.0) | 2315.8 (1219.5) | 1817.3 (926.5) |
Fruit and vegetable intake (g/day) | 157.6 (234.6) | 141.7 (219.7) | 167.1 (242.7) | 113.1 (242.8) | 88.8 (161.1) | 124.8 (272.9) |
Household size | 3.4 (2.0) | 3.0 (2.0) | 3.6 (2.0) | 4.4 (2.6) | 3.9 (2.8) | 4.6 (2.5) |
Fish Species | Ontario | Manitoba | ||||||
---|---|---|---|---|---|---|---|---|
Fish Intake | EPA + DHA | DDE | PCBs | Fish Intake | EPA + DHA | DDE | PCBs | |
g/day | g/100 g | ng/g | ng/g | g/day | g/100 g | ng/g | ng/g | |
walleye | 5.6 (13.5) | 0.31 (0.05) | 2.69 (3.36) | 14.75 (19.44) | 3.7 (9.1) | 0.31 (0.05) | - | - |
whitefish | 2.5 (9.6) | 1.24 (0.56) | 5.89 (7.21) | 14.56 (24.27) | 2.0 (8.1) | 1.24 (0.56) | 1.28 (0.79) | 0.21 (0.26) |
lake trout | 1.1 (5.6) | 0.73 (0.14) | 26.65 (24.32) | 63.69 (83.54) | 1.4 (5.9) | 0.73 (0.14) | 11.73 (5.76) | 9.24 (2.58) |
northern pike | 1.7 (7.5) | 0.27 (0.07) | 1.85 (1.94) | 8.98 (11.65) | 1.0 (4.0) | 0.27 (0.07) | 0.15 (0.31) | 0.03 (0.10) |
yellow perch | 0.5 (2.8) | 0.25 (0.04) | 3.11 (4.18) | 33.18 (62.47) | 0.2 (1.7) | 0.25 (0.04) | - | - |
subtotal | 11.5 (28.0) | 0.56 (0.42) | 6.28 (11.82) | 22.01 (40.49) | 8.4 (18.4) | 0.56 (0.42) | 1.06 (2.92) | 0.59 (2.21) |
total | 14.7 (34.1) | 0.67 (0.48) | 10.08 (19.62) | 35.21 (68.06) | 10.7 (24.5) | 0.53 (0.28) | 2.05 (4.37) | 2.00 (5.40) |
Variables | <5 g/day | 5–10 g/day | >10 g/day | |||
---|---|---|---|---|---|---|
Ontario | Mean | 95% CI | Mean | 95% CI | Mean | 95% CI |
Male | ||||||
n | 225 | 86 | 222 | |||
Total fish intake (g/day) | 1.28 | 0.93–1.64 | 7.11 | 6.58–7.63 | 62.19 | 41.48–82.89 |
EPA + DHA (mg/day) | 22.04 | 12.50–31.59 | 119.87 | 90.14–149.60 | 935.09 | 636.61–1235.36 |
DDE (ng/kg/day) | 0.08 | 0.04–0.12 | 0.31 | 0.13–0.50 | 3.19 | 1.60–4.76 |
PCBs (ng/kg/day) | 0.37 | 0.25–0.49 | 1.41 | 0.69–2.12 | 11.28 | 7.20–15.37 |
Female | ||||||
n | 573 | 113 | 207 | |||
Total fish intake (g/day) | 0.97 | 0.83–1.11 | 6.94 | 6.78–7.09 | 39.21 | 27.49–50.93 |
EPA + DHA (mg/day) | 14.65 | 12.00–17.31 | 115.24 | 100.57–129.90 | 550.63 | 398.00–703.28 |
DDE (ng/kg/day) | 0.06 | 0.04–0.09 | 0.5 | 0.26–0.65 | 3.61 | 1.39–5.84 |
PCBs (ng/kg/day) | 0.249 | 0.17–0.32 | 1.723 | 1.05–2.39 | 9.86 | 4.47–15.24 |
Manitoba | ||||||
Male | ||||||
n | 104 | 32 | 93 | |||
Total fish intake (g/day) | 1.61 | 0.66–2.57 | 6.9 | 6.29–7.50 | 34.4 | 19.74–49.07 |
EPA + DHA (mg/day) | 6.27 | 2.58–9.97 | 28.6 | 21.45–35.74 | 195.4 | 72.73–318.07 |
DDE (ng/kg/day) | 0.012 | 0.001–0.02 | 0.02 | 0.003–0.71 | 0.63 | 0.07–1.21 |
PCBs (ng/kg/day) | 0.012 | 0.002–0.03 | 0.02 | 0.005–0.09 | 0.45 | 0.09–0.81 |
Female | ||||||
n | 346 | 55 | 76 | |||
Total fish intake (g/day) | 1.31 | 1.08–1.54 | 7.02 | 6.75–7.29 | 30.85 | 26.92–34.78 |
EPA + DHA (mg/day) | 5.22 | 4.00–6.44 | 31.71 | 27.65–35.76 | 183.12 | 144.41–221.85 |
DDE (ng/kg/day) | 0.004 | 0.001–0.007 | 0.06 | 0.03–0.09 | 0.34 | 0.26–0.41 |
PCBs (ng/kg/day) | 0.003 | 0.0004–0.006 | 0.07 | 0.003–0.14 | 0.26 | 0.17–0.35 |
Variables | Total Population | Female | Male | ||
---|---|---|---|---|---|
Model 1 | Model 2 | Model 3 | Model 3 | Model 3 | |
T2D in Ontario First Nations | 0.53 ** (0.33–0.87) | 0.52 ** (0.30–0.91) | 0.53 * (0.27–1.03) | 0.64 (0.29–1.44) | 0.32 ** (0.12–0.82) |
Medium fish consumers | 0.43 ** (0.22–0.84) | 0.58 * (0.31–1.09) | 0.59 (0.29–1.18) | 0.29 *** (0.13–0.62) | 1.45 (0.46–4.56) |
Medium fish consumers in Ontario | 3.05 *** (1.32–7.08) | 2.12 * (0.94–4.77) | 2.22 * (0.86–5.68) | 3.08 ** (1.13–8.42) | 1.79 (0.27–11.67) |
High fish consumers in Ontario | 2.76 ** (1.25–6.09) | 3.39 *** (1.49–7.68) | 3.53 *** (1.47–8.45) | 14.96 *** (372–60.11) | 2.85 ** (1.14–8.04) |
n | 2080 | 2080 | 2080 | 1329 | 751 |
DDE Intake | PCB Intake | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Slope 1 (<BP) | BP | Slope 2 (>BP) | Slope 1 (<BP) | BP | Slope 2 (>BP) | ||||||
OR | 95% CI | ng/kg/day | SE | OR | 95% CI | OR | 95% CI | ng/kg/day | SE | OR | 95% CI |
1.03 | 0.99–1.07 | 2.11 | 1.53 | 2.29 | 1.26–4.17 | 1.00 | 0.96–1.03 | 1.47 | 1.95 | 1.44 | 1.09–1.89 |
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Marushka, L.; Hu, X.; Batal, M.; Sadik, T.; Schwartz, H.; Ing, A.; Fediuk, K.; Tikhonov, C.; Chan, H.M. The Relationship between Persistent Organic Pollutants Exposure and Type 2 Diabetes among First Nations in Ontario and Manitoba, Canada: A Difference in Difference Analysis. Int. J. Environ. Res. Public Health 2018, 15, 539. https://doi.org/10.3390/ijerph15030539
Marushka L, Hu X, Batal M, Sadik T, Schwartz H, Ing A, Fediuk K, Tikhonov C, Chan HM. The Relationship between Persistent Organic Pollutants Exposure and Type 2 Diabetes among First Nations in Ontario and Manitoba, Canada: A Difference in Difference Analysis. International Journal of Environmental Research and Public Health. 2018; 15(3):539. https://doi.org/10.3390/ijerph15030539
Chicago/Turabian StyleMarushka, Lesya, Xuefeng Hu, Malek Batal, Tonio Sadik, Harold Schwartz, Amy Ing, Karen Fediuk, Constantine Tikhonov, and Hing Man Chan. 2018. "The Relationship between Persistent Organic Pollutants Exposure and Type 2 Diabetes among First Nations in Ontario and Manitoba, Canada: A Difference in Difference Analysis" International Journal of Environmental Research and Public Health 15, no. 3: 539. https://doi.org/10.3390/ijerph15030539