Combined impact of heat and dust on diabetes hospitalization in Kuwait

Introduction In Kuwait, a severe diabetes and obesity epidemic coexists with intense dust storms and harsh summer heat. While, theoretically, this interplay between dust, heat, and diabetes presents a serious public health problem, the empirical understanding of the actual risks remains limited. We hypothesized that increased exposure to heat and dust, independently and jointly, exacerbates the risk of hospitalization for diabetes patients.Research design and methods We placed custom-designed particle samplers in Kuwait to collect daily dust samples for 2 years from 2017 to 2019. Samples were analyzed for elemental concentrations to identify and quantify dust pollution days. Temperature data were collected from meteorological stations. We then collected hospitalization data for unplanned diabetic admissions in all public hospitals in Kuwait. We used a case-crossover study design and conditional quasi-Poisson models to compare hospitalization days to control days within the same subject. Finally, we fitted generalized additive models to explore the smoothed interaction between temperature and dust days on diabetes hospitalization.Results There were 11 155 unplanned diabetes hospitalizations over the study period. We found that each year, there was an excess of 282 diabetic admissions attributed to hot days (95% CI: -14 to 473). Additionally, for every 10 mu g/m3 increase in dust levels, there were about 114 excess diabetic admissions annually (95% CI: 11 to 219). Compared with mild non-dusty days (33 degrees C (0 mu g/m3)), hot-dusty days jointly increased the relative risk of diabetic admissions from 1.11 at 42 degrees C (85 mu g/m3) to 1.36 at 42 degrees C (150 mu g/m3).Conclusions Both heat and dust seem to contribute to the increased diabetes morbidity, with combined hot-dusty conditions exacerbating these risks even further.