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IntroductionAir pollution represents a serious threat to health on a global scale, being responsible for a large portion of the global burden of disease from environmental factors. Current evidence about the association between air pollution exposure and Diabetes Mellitus (DM) is still controversial. We aimed to evaluate the association between area-level ambient air pollution and self-reported DM in a large population sample in Italy.Materials and methodsWe extracted information about self-reported and physician diagnosed DM, risk factors and socio-economic status from 12 surveys conducted nationwide between 1999 and 2013. We obtained annual averaged air pollution levels for the years 2003, 2005, 2007 and 2010 from the AMS-MINNI national integrated model, which simulates the dispersion and transformation of pollutants. The original maps, with a resolution of 4 x 4 km2, were normalized and aggregated at the municipality class of each Italian region, in order to match the survey data. We fit logistic regression models with a hierarchical structure to estimate the relationship between PM10, PM2.5, NO2 and O3 four-years mean levels and the risk of being affected by DM.ResultsWe included 376,157 individuals aged more than 45 years. There were 39,969 cases of DM, with an average regional prevalence of 9.8% and a positive geographical North-to-South gradient, opposite to that of pollutants’ concentrations. For each 10 μg/m3 increase, the resulting ORs were 1.04 (95% CI 1.01–1.07) for PM10, 1.04 (95% CI 1.02–1.07) for PM2.5, 1.03 (95% CI 1.01–1.05) for NO2 and 1.06 (95% CI 1.01–1.11) for O3, after accounting for relevant individual risk factors. The associations were robust to adjustment for other pollutants in two-pollutant models tested (ozone plus each other pollutant).ConclusionsWe observed a significant positive association between each examined pollutant and prevalent DM. Risk estimates were consistent with current evidence, and robust to sensitivity analysis. Our study adds evidence about the effects of air pollution on diabetes and suggests a possible role of ozone as an independent factor associated with the development of DM. Such relationship is of great interest for public health and deserves further investigation.

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This study is the follow up of the URBAN-MAES pilot implemented in the framework of the EnRoute project. The study aims at mapping and assessing the process of particulate matter (PM 10 ) and tropospheric ozone (O 3 ) removal by various forest and shrub ecosystems. Different policy levels and environmental contexts were considered, namely the Metropolitan city of Rome and, at a wider level, the Latium region. The approach involves characterization of the main land cover and ecosystems using Sentinel-2 images, enabling a detailed assessment of Ecosystem Service (ES), and monetary valuation based on externality values. The results showed spatial variations in the pattern of PM 10 and O 3 removal inside the Municipality and in the more rural Latium hinterland, reflecting the spatial dynamics of the two pollutants. Evergreen species displayed higher PM 10 removal efficiency, whereas deciduous species showed higher O 3 absorption in both rural and urban areas. The overall pollution removal accounted for 5123 and 19,074 Mg of PM 10 and O 3 , respectively, with a relative monetary benefit of 161 and 149 Million Euro for PM 10 and O 3 , respectively. Our results provide spatially explicit evidence that may assist policymakers in land-oriented decisions towards improving Green Infrastructure and maximizing ES provision at different governance levels.