How Outdoor Air Pollution Contributes to Rising Diabetes Mortality: A Global Analysis

The global rise in diabetes is an urgent public health challenge, affecting millions worldwide. While lifestyle factors such as diet and physical inactivity are primary contributors, an often-overlooked factor is outdoor air pollution, specifically fine particulate matter (PM2.5). These tiny particles in the air are increasingly recognized as a major contributor to diabetes-related mortality, making this an emerging and critical public health issue. Recent data highlights that outdoor air pollution contributes to rising diabetes mortality, as per the current data, urging immediate attention to this growing crisis.

What Is Fine Particulate Matter (PM2.5)?

Fine particulate matter, or PM2.5, refers to airborne particles that are smaller than 2.5 micrometers in diameter. These particles are so small that they can penetrate deep into the lungs and even enter the bloodstream. Sources of PM2.5 include motor vehicle exhaust, industrial emissions, agricultural activities, and burning of fossil fuels. Long-term exposure to PM2.5 linked to a range of health problems, including respiratory diseases, cardiovascular diseases, and, increasingly, diabetes.

Recent research shows that PM2.5 exposure triggers inflammation and oxidative stress in the body, both of which contribute to insulin resistance—a hallmark of type 2 diabetes. This connection between diabetes and air pollution highlights a dangerous combination of factors that exacerbate the global burden of non-communicable diseases (NCDs). Worse, diabetes itself can lead to severe complications such as kidney disease, blindness, and heart disease, making it a potentially deadly combination when compounded by poor air quality.

The Growing Problem of Diabetes Mortality Due to Air Pollution

Air pollution’s role in increasing diabetes mortality is complex but well-documented. Long-term exposure to PM2.5 can damage the pancreas, impair insulin secretion, and elevate body-wide inflammation, which worsens insulin resistance. This has a profound impact on people already living with diabetes, contributing to both the development and worsening of the condition.

According to the Health Effects Institute’s 2024 State of Global Air report, 18% of diabetes deaths worldwide in 2021 attributed to outdoor air pollution, underscoring the urgent need to address air quality in regions with high pollution levels. While these percentages vary across countries, the evidence clearly points to air pollution as a significant, and growing, contributor to diabetes mortality.

Geographic Distribution of Outdoor Air Pollution Contributes to Rising Diabetes Mortality

The impact of outdoor air pollution on diabetes-related deaths is not evenly distributed across the globe. The regions most affected are typically those with high industrial activity, dense populations, and inadequate air quality regulations. As a result, countries with severe air pollution problems are facing a double burden on public health—rising rates of diabetes and increasing pollution-related deaths.

In countries where air pollution is high—such as parts of the Middle East, South Asia, and East Asia—the percentage of diabetes deaths attributed to outdoor fine particles is alarmingly high. For instance:

• Oman, Qatar, Saudi Arabia, Jordan, Iran, Iraq, and Kuwait each report that 20% of diabetes deaths are attributable to outdoor air pollution.
• Thailand and Tunisia follow closely with 19% of diabetes deaths linked to air pollution.

These figures underscore the need for urgent action in regions where both diabetes and pollution are major health concerns. The combination of poor air quality and high diabetes prevalence exacerbates the risks to public health, creating a severe and avoidable burden on healthcare systems.

A Call for Action in Regions with Lower Air Pollution

In contrast, regions with more stringent environmental regulations, better air quality management, and lower levels of industrialisation tend to report lower percentages of diabetes deaths due to air pollution. Countries in Europe and North America, for instance, typically see diabetes-related deaths due to pollution in the range of 5% to 12%. However, even in these regions, outdoor air pollution contributes to rising diabetes mortality, reminding us that no region is immune to the dangers of poor air quality.

Countries like France, Germany, and the Netherlands show that even in relatively cleaner regions, air pollution remains a significant factor in exacerbating diabetes mortality. This calls for a continuous commitment to improving air quality, even in areas where pollution levels are lower.

Why Does the Geographic Distribution of Diabetes Mortality Matter?

Understanding the geographic distribution of diabetes mortality due to air pollution is vital for directing resources and efforts where they are needed most. Countries experiencing high rates of pollution-related diabetes deaths need to prioritise air quality improvements and diabetes management programs to mitigate this double burden on public health. Addressing air pollution could prevent a significant number of diabetes-related deaths, making it an urgent priority for policymakers.

By improving air quality in these high-risk regions, governments can reduce the health burden on populations, prevent future cases of diabetes, and ultimately improve the overall quality of life for millions of people.

Countries Most Affected by Air Pollution and Diabetes Mortality

The global data clearly shows that certain countries are disproportionately affected by outdoor air pollution contributes to rising diabetes mortality. Here is a snapshot of some of the countries most impacted by this dual threat, with the highest percentages of diabetes deaths attributed to outdoor air pollution:

These countries face a unique and critical challenge, with significant portions of diabetes-related deaths linked directly to outdoor air pollution. To address this, there is an urgent need for stronger environmental policies, improved diabetes management strategies, and collaborative global efforts to reduce emissions. Data Source (UNEP)

Sl.No.	Country	% Diabetes Deaths Attributable To Outdoor Air Pollution
1	Rep. of Korea	20
2	Islamic Rep. of Iran	20
3	Iraq	20
4	Syrian Arab Rep.	20
5	Saudi Arabia	20
6	Bahrain	20
7	Egypt	20
8	Jordan	20
9	Kuwait	20
10	Libya	20
11	United Arab Emirates	20
12	Oman	20
13	Qatar	20
14	Barbados	19
15	Türkiye	19
16	Armenia	19
17	Algeria	19
18	Thailand	19
19	Tunisia	19
20	State of Palestine	19
21	Equatorial Guinea	19
22	Saint Lucia	18
23	Saint Vincent and the Grenadines	18
24	Grenada	18
25	Lebanon	18
26	Trinidad and Tobago	18
27	Israel	18
28	Suriname	18
29	Gabon	18
30	Chile	18
31	Poland	17
32	Antigua and Barbuda	17
33	Cuba	17
34	Kazakhstan	17
35	Serbia	17
36	Azerbaijan	17
37	North Macedonia	17
38	China	17
39	Turkmenistan	17
40	Morocco	17
41	Malaysia	17
42	Peru	17
43	Slovakia	16
44	Bahamas	16
45	Bulgaria	16
46	Dominican Rep.	16
47	Uzbekistan	16
48	Dominica	16
49	Cyprus	16
50	Guyana	16
51	Ecuador	16
52	Singapore	16
53	Belarus	15
54	Czechia	15
55	Hungary	15
56	Romania	15
57	Slovenia	15
58	Belize	15
59	Croatia	15
60	Bosnia and Herzegovina	15
61	Montenegro	15
62	Bhutan	15
63	Cabo Verde	15
64	Venezuela	15
65	Botswana	15
66	Mexico	14
67	Italy	14
68	Mongolia	14
69	Argentina	14
70	South Africa	14
71	Ukraine	13
72	Japan	13
73	Georgia	13
74	Malta	13
75	Jamaica	13
76	Albania	13
77	Costa Rica	13
78	Colombia	13
79	Latvia	12
80	Netherlands	12
81	Belgium	12
82	Austria	12
83	El Salvador	12
84	Panama	12
85	Sri Lanka	12
86	Bolivia	12
87	Djibouti	12
88	Maldives	12
89	Germany	11
90	Russian Fed.	11
91	San Marino	11
92	India	11
93	Indonesia	11
94	Namibia	11
95	Lithuania	10
96	Denmark	10
97	France	10
98	Rep. of Moldova	10
99	Mauritania	10
100	Philippines	10
101	Sudan	10
102	Yemen	10
103	Brazil	10
104	Guam	10
105	Uruguay	10
106	Angola	10
107	Eswatini	10
108	Switzerland	9
109	Spain	9
110	Pakistan	9
111	Nigeria	9
112	Seychelles	9
113	Australia	9
114	Mauritius	9
115	Luxembourg	8
116	Guatemala	8
117	Kyrgyzstan	8
118	Tajikistan	8
119	Viet Nam	8
120	Ghana	8
121	Congo	8
122	Fiji	8
123	Ireland	7
124	Portugal	7
125	Saint Kitts and Nevis	7
126	United States Virgin Islands	7
127	Brunei Darussalam	7
128	Palau	7
129	Paraguay	7
130	United States of America	6
131	Bermuda	6
132	Myanmar	6
133	Nepal	6
134	New Zealand	6
135	Estonia	5
136	Greenland	5
137	Honduras	5
138	Lao People’s Dem. Rep.	5
139	Cameroon	5
140	Tokelau	5
141	Sao Tome and Principe	5
142	Timor-Leste	5
143	American Samoa	5
144	Niue	5
145	Sweden	4
146	Norway	4
147	Canada	4
148	Nicaragua	4
149	Bangladesh	4
150	Gambia	4
151	Burkina Faso	4
152	Mali	4
153	Benin	4
154	Chad	4
155	Nauru	4
156	Tonga	4
157	Finland	3
158	Iceland	3
159	Afghanistan	3
160	Cambodia	3
161	Senegal	3
162	Eritrea	3
163	Guinea	3
164	Guinea-Bissau	3
165	Niger	3
166	Sierra Leone	3
167	South Sudan	3
168	Togo	3
169	Ethiopia	3
170	Fed. States of Micronesia	3
171	Marshall Islands	3
172	Uganda	3
173	Kenya	3
174	Samoa	3
175	Zambia	3
176	Lesotho	3
177	Haiti	2
178	Dem. People’s Rep. of Korea	2
179	Central African Rep.	2
180	Liberia	2
181	Papua New Guinea	2
182	Rwanda	2
183	United Rep. of Tanzania	2
184	Zimbabwe	2
185	Somalia	1
186	Tuvalu	1
187	Kiribati	1
188	Burundi	1
189	Comoros	1
190	Malawi	1
191	Solomon Islands	1
192	Madagascar	1
193	Mozambique	1
194	Vanuatu	1

Strategies to Reduce Diabetes Mortality Due to Air Pollution

While reducing diabetes mortality due to outdoor air pollution is a global challenge, several strategies can help mitigate the effects of air pollution and reduce the burden of diabetes. Here are some key strategies:

1. Stricter Environmental Regulations: Governments must implement and enforce stricter air quality regulations to limit industrial emissions, reduce vehicular pollution, and control agricultural activities that contribute to particulate matter in the air. Policies that prioritise cleaner energy sources, such as solar and wind, can help reduce the amount of air pollution.
2. Urban Planning and Green Spaces: In rapidly growing urban areas, it is essential to integrate green spaces and promote public transportation to reduce air pollution from traffic. Urban planning that prioritises green spaces and the use of electric vehicles can help reduce the harmful effects of PM2.5.
3. Public Awareness and Health Education: Public health campaigns that raise awareness about the link between air pollution and diabetes are essential. Educating people on how to reduce their exposure to air pollution, such as staying indoors during high pollution events or using air purifiers, can help mitigate the health impacts.
4. International Cooperation: Air pollution is a global problem that requires international cooperation to solve. Collaborative efforts to address transboundary air pollution and share best practices for reducing emissions can help improve air quality on a global scale.
5. Health Infrastructure: Strengthening healthcare systems to address the dual burden of diabetes and air pollution is crucial. Healthcare providers should be equipped with the tools and knowledge to educate patients about the risks of air pollution and its role in diabetes progression.

Conclusion: The Urgency of Addressing Air Pollution and Diabetes

The data paints a clear picture—outdoor air pollution mainly contributes to rising diabetes mortality, and the regions most affected are those with the highest pollution levels and growing industrialization. To tackle this issue, governments must prioritize cleaner air and healthier environments, implement stricter regulations, and invest in sustainable practices.

As individuals, we can also contribute by advocating for policies that reduce air pollution and supporting actions that protect public health. Only through collective effort can we begin to curb the devastating effects of air pollution on diabetes and create a healthier, more sustainable world for future generations.