Background This study investigated the association between heatwave exposure and the risk of new-onset diabetes among middle-aged and older adults, and further assessed the modifying effects of air pollution and green space. Methods Data were obtained from two follow-up waves of the China Health and Retirement Longitudinal Study (CHARLS) conducted in 2015 and 2018, involving 6,591 adults aged ≥ 45 years who were free of diabetes at baseline. Twelve city-specific heatwave definitions were constructed based on the 90th–97.5th percentiles of daily maximum temperatures combined with durations of ≥ 2, ≥3, or ≥ 4 consecutive days. Generalized additive models and generalized difference-in-differences (G-DiD) analyses were employed to assess the associations between changes in heatwave exposure (days/events) and new-onset diabetes risk. Potential modifying effects of fine particulate matter (PM2.5) and Normalized Difference Vegetation Index (NDVI) were also examined. Results Using heatwave definitions HW2 (≥ 90th percentile for 3 days) and HW12 (≥ 97.5th percentile for 4 days), significant associations between heatwave exposure and increased diabetes incidence were observed (OR = 1.160, 95% CI: 1.008–1.334 and OR = 1.224, 95% CI: 1.012–1.480, respectively). Stratified analyses showed that the association weakened in areas with greater reductions in PM2.5. Additionally, areas with higher NDVI demonstrated a protective modifying effect. Subgroup analyses further indicated a higher diabetes risk among males, individuals aged ≥ 60 years, and those with baseline chronic diseases. Conclusion Heatwave exposure of specific intensity and duration increases the risk of new-onset diabetes, whereas improved air quality and higher vegetation coverage have protective effects. Males, individuals aged 60 years and older, and those with existing chronic diseases are more susceptible. Given ongoing climate change, public health strategies should incorporate high-temperature warnings, air quality management, and urban greening to protect high-risk populations.

The association between heatwave exposure and the risk of incident diabetes in middle-aged and older adults: a cohort study based on CHARLS

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2025年12月20日

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Wenfei Yang,
Yan Lin,
Caihua Ye,
Xiang Zhang,
Xinjun Jiang

摘要

Background

This study investigated the association between heatwave exposure and the risk of new-onset diabetes among middle-aged and older adults, and further assessed the modifying effects of air pollution and green space.

Methods

Data were obtained from two follow-up waves of the China Health and Retirement Longitudinal Study (CHARLS) conducted in 2015 and 2018, involving 6,591 adults aged ≥ 45 years who were free of diabetes at baseline. Twelve city-specific heatwave definitions were constructed based on the 90th–97.5th percentiles of daily maximum temperatures combined with durations of ≥ 2, ≥3, or ≥ 4 consecutive days. Generalized additive models and generalized difference-in-differences (G-DiD) analyses were employed to assess the associations between changes in heatwave exposure (days/events) and new-onset diabetes risk. Potential modifying effects of fine particulate matter (PM_2.5) and Normalized Difference Vegetation Index (NDVI) were also examined.

Results

Using heatwave definitions HW2 (≥ 90th percentile for 3 days) and HW12 (≥ 97.5th percentile for 4 days), significant associations between heatwave exposure and increased diabetes incidence were observed (OR = 1.160, 95% CI: 1.008–1.334 and OR = 1.224, 95% CI: 1.012–1.480, respectively). Stratified analyses showed that the association weakened in areas with greater reductions in PM_2.5. Additionally, areas with higher NDVI demonstrated a protective modifying effect. Subgroup analyses further indicated a higher diabetes risk among males, individuals aged ≥ 60 years, and those with baseline chronic diseases.

Conclusion

Heatwave exposure of specific intensity and duration increases the risk of new-onset diabetes, whereas improved air quality and higher vegetation coverage have protective effects. Males, individuals aged 60 years and older, and those with existing chronic diseases are more susceptible. Given ongoing climate change, public health strategies should incorporate high-temperature warnings, air quality management, and urban greening to protect high-risk populations.