The Burden of Type 2 Diabetes Attributable to Air Pollution in Iran at National and Provincial Level: A Review of Gbd 2021 Findings Publisher



Noori M ; Sattarpour R ; Moradilakeh M ; Baradaran HR ; Tehranibanihashemi A ; Yarahmadi R ; Naghavi M
Source: Journal of Diabetes and Metabolic Disorders Published:2026

Abstract

Background: Type 2 diabetes is a major and growing public health challenge worldwide, contributing substantially to premature mortality and disability. Increasing evidence suggests that long-term exposure to air pollution, plays an important role in the development and progression of type 2 diabetes. Countries with high levels of ambient air pollution may therefore experience a disproportionate diabetes burden attributable to environmental exposure. In Iran, where both diabetes prevalence and air pollution levels are high, national- and subnational-level evidence on the burden of type 2 diabetes attributable to air pollution remains limited. Objective: This study aimed to estimate the national and provincial burden of type 2 diabetes attributable to air pollution in Iran using data from the Global Burden of Disease (GBD) 2021 study. Methods: We used the GBD 2021 data in order to estimate mortality and disability-adjusted life years (DALYs) due to type 2 diabetes attributable to air pollution in Iran from 1990 to 2021. Exposure to air pollution included both ambient fine particulate matter and household air pollution from solid fuels, assessed using GBD exposure models that integrate satellite observations, ground-based measurements, and chemical transport modeling. The population-attributable fraction (PAF) was calculated to quantify the contribution of air pollution to type 2 diabetes using established GBD comparative risk assessment methods. Estimates were produced at national and provincial levels and stratified by age, sex, and year. Results: In 2021, air pollution was responsible for 2,872.92 (95% UI: 1,759.53-3,996.92) deaths and 156,407.93 (90,133.32–235,484.04) DALYs due to type 2 diabetes in Iran. Annually, the age-standardized mortality and DALY rate of type 2 diabetes attributable to air pollution increased by 1.89% (1.66–2.09) and 2.5% (2.34–2.6) during 1990–2021, respectively. Moreover, in 2021, the age-standardized PAF for type 2 diabetes mortality and DALY due to air pollution was 20.13% and 19.96%, respectively. Marked heterogeneity was observed across population subgroups and provinces. The attributable burden was consistently higher among women than men and increased sharply with age, with the highest mortality observed in individuals aged 75 years and older. Substantial provincial variation was also evident, with the highest age-standardized mortality and DALY rates were observed in Tehran (8.34 and 272.83 per 100,000 individuals, respectively) and Khuzestan (5.94 and 268.08 per 100,000 individuals, respectively) provinces. Conclusion: Air pollution contributes substantially to the burden of type 2 diabetes in Iran, with disproportionately higher impacts among women and older adults, likely reflecting a combination of biological susceptibility, longer cumulative exposure, and social and health-system factors affecting disease management and survival. Pronounced provincial disparities appear to be driven by differences in urbanization, industrial emissions, and exposure to dust storms. These findings highlight the need for context-specific policies, including targeted air quality interventions in high-burden provinces, strengthened diabetes screening and management among older adults and women, and integrated environmental and public health strategies. © The Author(s), under exclusive licence to Tehran University of Medical Sciences 2026.