AUTHOR=Bai Jianjun , Shi Fang , Ma Yudiyang , Yang Donghui , Yu Chuanhua , Cao Jinhong 

TITLE=The Global Burden of Type 2 Diabetes Attributable to Tobacco: A Secondary Analysis From the Global Burden of Disease Study 2019

JOURNAL=Frontiers in Endocrinology

VOLUME=Volume 13 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2022.905367

DOI=10.3389/fendo.2022.905367

ISSN=1664-2392

ABSTRACT=Objectives: Growing epidemiological studies have reported the relationship between tobacco and health loss among patients with type 2 diabetes (T2D). This study aimed to explore the secular trend and spatial distribution of the T2D burden attributable to tobacco on a global scale to better understand regional disparities and judge the gap between current conditions and expectations.
Methods: As a secondary analysis, we extracted data of tobacco-attributable T2D burden from the Global Burden of Disease Study (GBD) 2019. Joinpoint regression was adopted to determine the secular trend of age-standardized rates (ASR), with average annual percentage change (AAPC). Gaussian process regression (GPR) was to explore the average expected relationship between ASRs and socio-demographic index (SDI). Spatial autocorrelation was to indicate if there is clustering of age-standardized DALY rate (ASDR), with Moran's I value. Multi-scale geographically weighted regression (MGWR) was to investigate the spatial distribution and scales of influencing factors in ASDR attributable to tobacco, with the regression coefficients for each influencing factor among 204 countries. 
Results: Tobacco posed a challenge to global T2D health, particularly for the elderly and males from lower SDI regions. While for females, the mortality attributable to secondhand smoke was higher than smoking. A downward trend in age-standardized mortality rate (ASMR) of T2D attributable to tobacco was observed (AAPCs= -0.24; 95% CI -0.3. to -0.18), while the ASDR remained increasing since 1990 globally (AAPCs= 0.19; 0.11 to 0.27). Oceania, Southern Sub-Saharan Africa, and Southeast Asia had the highest ASMRs and ASDRs, exceeding expectations based on SDI. Besides, "high-high" clusters were mainly observed in South Africa and Southeast Asian countries, which means high-ASDR country is surrounded by the high-ASDR neighborhoods in the above areas. According to MGWR model, smoking prevalence was the most sensitive influencing factor, with regression coefficients from 0.15 to 1.80.
Conclusion: The tobacco-attributable burden of T2D should be considered as an important health issue, especially in low-middle and middle SDI regions. Meanwhile, secondhand smoke posed a greater risk to females. Regional disparities existed, with hot spots mainly concentrated in South Africa and Southeast Asian countries.