Global Burden of Type 2 Diabetes Attributable to Secondhand Smoke: A Comprehensive Analysis from the GBD 2021 Study

Dongke Guo Yanna Yu Zhongxin Zhu ^*

• The First people's Hospital of Xiaoshan District, Hangzhou, China

Secondhand smoke (SHS) exposure represents an underappreciated global health risk for type 2 diabetes mellitus (T2DM), with complex epidemiological implications. Leveraging the comprehensive Global Burden of Disease (GBD) 2021 dataset, we systematically evaluated the worldwide burden of type 2 diabetes mellitus attributable to secondhand smoke (T2DM-SHS) across 204 countries. The analysis encompassed both death and disability-adjusted life years (DALYs) across various genders, age groups, and 204 nations over the period from 1990 to 2021. We examined trends and socioeconomic impacts by analyzing age-standardized DALYs rates and estimated annual percentage changes, stratified by socio-demographic Index (SDI) quintiles. The following changes occurred between 1990 and 2021: while age-standardized mortality rates decreased by 8.903% (95% UI: -16.824% to -1.399%), DALYs increased by 17.049% (95% UI: 9.065% to 25.557%). Age-stratified analysis revealed peak death in the 70-74 years group, with females experiencing highest DALYs in the 75-79 years group and males in the 90-94 years group. An inverted U-shaped relationship between SDI and disease burden emerged, with peak rates at moderate SDI levels. Despite lowest burdens in high-income countries, disease dynamics were most complex in middle-range SDI countries, indicating that economic development does not linearly correlate with health outcomes. This comprehensive analysis unveils the multifaceted global landscape of T2DM-SHS, exposing critical disparities across gender, age, and socioeconomic contexts. The findings urgently call for targeted, context-specific public health interventions, particularly in low-and middleincome countries, to mitigate the escalating T2DM-SHS burden.