The relationship between traffic-related air pollution exposures and allostatic load score among youth with type 1 diabetes in the SEARCH cohort

Jessica A. Montresor-López; Stephanie R. Reading; Jeffrey D. Yanosky; Murray A. Mittleman; Ronny A. Bell; Tessa L. Crume; Dana Dabelea; Lawrence Dolan; Ralph B. D'Agostino; Santica M. Marcovina; Catherine Pihoker; Kristi Reynolds; Elaine Urbina; Angela D. Liese; Lesliam Quirós-Alcalá; J. Carson Smith; P. Jacob Bueno de Mesquita; Robin C. Puett

doi:10.1016/j.envres.2021.111075

The relationship between traffic-related air pollution exposures and allostatic load score among youth with type 1 diabetes in the SEARCH cohort

Jessica A. Montresor-López, Stephanie R. Reading, Jeffrey D. Yanosky, Murray A. Mittleman, Ronny A. Bell, Tessa L. Crume, Dana Dabelea, Lawrence Dolan, Ralph B. D'Agostino, Santica M. Marcovina, Catherine Pihoker, Kristi Reynolds, Elaine Urbina, Angela D. Liese, Lesliam Quirós-Alcalá, J. Carson Smith, P. Jacob Bueno de Mesquita, Robin C. Puett

Bloomberg School of Public Health

Research output: Contribution to journal › Article › peer-review

Abstract

Objective: We investigated the effects of chronic exposures to particulate and traffic-related air pollution on allostatic load (AL) score, a marker of cumulative biological risk, among youth with type 1 diabetes. Research design and methods: Participants were drawn from five clinical sites of the SEARCH for Diabetes in Youth (SEARCH) study (n = 2338). Baseline questionnaires, anthropometric measures, and a fasting blood test were taken at a clinic visit between 2001 and 2005. AL was operationalized using 10 biomarkers reflecting cardiovascular, metabolic, and inflammatory risk. Annual residential exposures to PM_2.5 and proximity to heavily-trafficked major roadways were estimated for each participant. Poisson regression models adjusted for sociodemographic and lifestyle factors were conducted for each exposure. Results: No significant associations were observed between exposures to PM_2.5 or proximity to traffic and AL score, however analyses were suggestive of effect modification by race for residential distance to heavily-trafficked major roadways (p = 0.02). In stratified analyses, residing <100, 100-<200 and 200-<400 m compared to 400 m or more from heavily-trafficked major roadways was associated with 11%, 26% and 14% increases in AL score, respectively (95% CIs: -4, 29; 9, 45; −1, 30) for non-white participants compared to 6%, −2%, and −2% changes (95% CIs: -2, 15; −10, 7; −8, 6) for white participants. Conclusions: Among this population of youth with type 1 diabetes, we did not observe consistent relationships between chronic exposures to particulate and traffic-related air pollution and changes in AL score, however associations for traffic-related pollution exposures may differ by race/ethnicity and warrant further examination.

Original language	English (US)
Article number	111075
Journal	Environmental research
Volume	197
DOIs	https://doi.org/10.1016/j.envres.2021.111075
State	Published - Jun 2021

Keywords

Air pollution
Allostatic load
Chronic exposure
Type 1 diabetes

ASJC Scopus subject areas

Biochemistry
Environmental Science(all)

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10.1016/j.envres.2021.111075

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Montresor-López, J. A., Reading, S. R., Yanosky, J. D., Mittleman, M. A., Bell, R. A., Crume, T. L., Dabelea, D., Dolan, L., D'Agostino, R. B., Marcovina, S. M., Pihoker, C., Reynolds, K., Urbina, E., Liese, A. D., Quirós-Alcalá, L., Smith, J. C., Bueno de Mesquita, P. J., & Puett, R. C. (2021). The relationship between traffic-related air pollution exposures and allostatic load score among youth with type 1 diabetes in the SEARCH cohort. Environmental research, 197, [111075]. https://doi.org/10.1016/j.envres.2021.111075

Montresor-López, JA, Reading, SR, Yanosky, JD, Mittleman, MA, Bell, RA, Crume, TL, Dabelea, D, Dolan, L, D'Agostino, RB, Marcovina, SM, Pihoker, C, Reynolds, K, Urbina, E, Liese, AD, Quirós-Alcalá, L, Smith, JC, Bueno de Mesquita, PJ & Puett, RC 2021, 'The relationship between traffic-related air pollution exposures and allostatic load score among youth with type 1 diabetes in the SEARCH cohort', Environmental research, vol. 197, 111075. https://doi.org/10.1016/j.envres.2021.111075

@article{12f032af0ed14d38944109844e4f6731,

title = "The relationship between traffic-related air pollution exposures and allostatic load score among youth with type 1 diabetes in the SEARCH cohort",

abstract = "Objective: We investigated the effects of chronic exposures to particulate and traffic-related air pollution on allostatic load (AL) score, a marker of cumulative biological risk, among youth with type 1 diabetes. Research design and methods: Participants were drawn from five clinical sites of the SEARCH for Diabetes in Youth (SEARCH) study (n = 2338). Baseline questionnaires, anthropometric measures, and a fasting blood test were taken at a clinic visit between 2001 and 2005. AL was operationalized using 10 biomarkers reflecting cardiovascular, metabolic, and inflammatory risk. Annual residential exposures to PM2.5 and proximity to heavily-trafficked major roadways were estimated for each participant. Poisson regression models adjusted for sociodemographic and lifestyle factors were conducted for each exposure. Results: No significant associations were observed between exposures to PM2.5 or proximity to traffic and AL score, however analyses were suggestive of effect modification by race for residential distance to heavily-trafficked major roadways (p = 0.02). In stratified analyses, residing <100, 100-<200 and 200-<400 m compared to 400 m or more from heavily-trafficked major roadways was associated with 11%, 26% and 14% increases in AL score, respectively (95% CIs: -4, 29; 9, 45; −1, 30) for non-white participants compared to 6%, −2%, and −2% changes (95% CIs: -2, 15; −10, 7; −8, 6) for white participants. Conclusions: Among this population of youth with type 1 diabetes, we did not observe consistent relationships between chronic exposures to particulate and traffic-related air pollution and changes in AL score, however associations for traffic-related pollution exposures may differ by race/ethnicity and warrant further examination.",

keywords = "Air pollution, Allostatic load, Chronic exposure, Type 1 diabetes",

author = "Montresor-L{\'o}pez, {Jessica A.} and Reading, {Stephanie R.} and Yanosky, {Jeffrey D.} and Mittleman, {Murray A.} and Bell, {Ronny A.} and Crume, {Tessa L.} and Dana Dabelea and Lawrence Dolan and D'Agostino, {Ralph B.} and Marcovina, {Santica M.} and Catherine Pihoker and Kristi Reynolds and Elaine Urbina and Liese, {Angela D.} and Lesliam Quir{\'o}s-Alcal{\'a} and Smith, {J. Carson} and {Bueno de Mesquita}, {P. Jacob} and Puett, {Robin C.}",

note = "Funding Information: Funding for the SEARCH Air Ancillary Study is from the National Institutes of Health , National Institute of Environmental Health Sciences (grant number R01 ES019168 ). The SEARCH for Diabetes in Youth Study is funded by the Centers for Disease Control and Prevention (PA numbers 00097 , DP-05-069 , and DP-10-001 ) and additionally supported by the National Institute of Diabetes and Digestive and Kidney Diseases . Support was also provided by the South Carolina Clinical & Translational Research Institute at the Medical University of South Carolina (NIH/ National Center for Advancing Translational Sciences ( NCATS ) grant number UL1 TR000062 ); Seattle Children{\textquoteright}s Hospital and the University of Washington (NIH/ NCATS grant number UL1 TR00423 ); University of Colorado Pediatric Clinical and Translational Research Center (NIH/ NCATS grant Number UL1 TR000154 ); the Barbara Davis Center at the University of Colorado Denver (DERC NIH grant number P30 DK57516 ); the University of Cincinnati (NIH/NCATS grant number UL1 TR000077 ); and the Children with Medical Handicaps program managed by the Ohio Department of Health . The sponsors had no involvement in study design; in data collection, analysis and interpretation; in writing of the manuscript; and in the decision to submit the article for publication. Funding Information: Funding for the SEARCH Air Ancillary Study is from the National Institutes of Health, National Institute of Environmental Health Sciences grant R01 ES019168. The SEARCH for Diabetes in Youth Study is funded by the Centers for Disease Control and Prevention (PA numbers 00097, DP-05-069, and DP-10-001) and additionally supported by the National Institute of Diabetes and Digestive and Kidney Diseases. Support was also provided by the South Carolina Clinical & Translational Research Institute at the Medical University of South Carolina, NIH/National Center for Advancing Translational Sciences (NCATS) grant number UL1 TR000062; Seattle Children's Hospital and the University of Washington, NIH/NCATS grant number UL1 TR00423; University of Colorado Pediatric Clinical and Translational Research Center, NIH/NCATS grant Number UL1 TR000154; the Barbara Davis Center at the University of Colorado at Denver (DERC NIH grant number P30 DK57516); the University of Cincinnati, NIH/NCATS grant number UL1 TR000077; and the Children with Medical Handicaps program managed by the Ohio Department of Health. The sponsors had no involvement in study design; in data collection, analysis and interpretation; in writing of the manuscript; and in the decision to submit the article for publication.The authors graciously thank everyone involved with the SEARCH for Diabetes in Youth study ? including participants and their families, as well as health care providers ? without whom this study would not have been possible. The authors also thank James Hibbert, University of South Carolina, for geocoding addresses, and Verada Shevade, University of Maryland, for assisting with formatting. Funding for the SEARCH Air Ancillary Study is from the National Institutes of Health, National Institute of Environmental Health Sciences (grant number R01 ES019168). The SEARCH for Diabetes in Youth Study is funded by the Centers for Disease Control and Prevention (PA numbers 00097, DP-05-069, and DP-10-001) and additionally supported by the National Institute of Diabetes and Digestive and Kidney Diseases. Support was also provided by the South Carolina Clinical & Translational Research Institute at the Medical University of South Carolina (NIH/National Center for Advancing Translational Sciences (NCATS) grant number UL1 TR000062); Seattle Children's Hospital and the University of Washington (NIH/NCATS grant number UL1 TR00423); University of Colorado Pediatric Clinical and Translational Research Center (NIH/NCATS grant Number UL1 TR000154); the Barbara Davis Center at the University of Colorado Denver (DERC NIH grant number P30 DK57516); the University of Cincinnati (NIH/NCATS grant number UL1 TR000077); and the Children with Medical Handicaps program managed by the Ohio Department of Health. The sponsors had no involvement in study design; in data collection, analysis and interpretation; in writing of the manuscript; and in the decision to submit the article for publication. Contract numbers for SEARCH sites include: Kaiser Permanente Southern California (U18DP006133, U48/CCU919219, U01 DP000246, and U18DP002714), University of Colorado Denver (U18DP006139, U48/CCU819241-3, U01 DP000247, and U18DP000247-06A1), Children's Hospital Medical Center (Cincinnati) (U18DP006134, U48/CCU519239, U01 DP000248, and 1U18DP002709), University of North Carolina at Chapel Hill (U18DP006138, U48/CCU419249, U01 DP000254, and U18DP002708), Seattle Children's Hospital (U18DP006136, U58/CCU019235-4, U01 DP000244, and U18DP002710-01), Wake Forest University School of Medicine (U18DP006131, U48/CCU919219, U01 DP000250, and 200-2010-35171). The SEARCH writing group for this manuscript included J.M. (vice chair), S.R. J.Y. R.B. T.C. L.D. R.D. C.P. K.R. A.L. and R.P (chair). J.M. developed the concept for the manuscript, analyzed data, and wrote the manuscript. S.R. and K.R. contributed to the development of the AL index and reviewed/edited the manuscript. J.Y. developed the exposure models, contributed to the methods, and reviewed/edited the manuscript. M.M. provided epidemiological expertise and reviewed/edited the manuscript. R.D. provided statistical expertise and assisted with analysis. R.B. T.C. D.D, L.D, S.M. C.P. P.J.B. and J.S. reviewed/edited the manuscript. E.U. provided medical expertise related to the biomarkers in the AL score and reviewed/edited the manuscript. A.L. contributed to the development of the manuscript and reviewed/edited. L.Q. assisted with analysis and reviewed/edited the manuscript. R.P. assisted with the development of the manuscript, contributed to the analysis and discussion, and reviewed/edited. The guarantors are J.M. and R.P. The authors declare no relevant conflicts of interest. Funding Information: Funding for the SEARCH Air Ancillary Study is from the National Institutes of Health , National Institute of Environmental Health Sciences grant R01 ES019168 . The SEARCH for Diabetes in Youth Study is funded by the Centers for Disease Control and Prevention (PA numbers 00097 , DP-05-069 , and DP-10-001 ) and additionally supported by the National Institute of Diabetes and Digestive and Kidney Diseases . Support was also provided by the South Carolina Clinical & Translational Research Institute at the Medical University of South Carolina , NIH / National Center for Advancing Translational Sciences ( NCATS ) grant number UL1 TR000062 ; Seattle Children{\textquoteright}s Hospital and the University of Washington , NIH / NCATS grant number UL1 TR00423 ; University of Colorado Pediatric Clinical and Translational Research Center , NIH / NCATS grant Number UL1 TR000154 ; the Barbara Davis Center at the University of Colorado at Denver (DERC NIH grant number P30 DK57516 ); the University of Cincinnati , NIH / NCATS grant number UL1 TR000077 ; and the Children with Medical Handicaps program managed by the Ohio Department of Health . The sponsors had no involvement in study design; in data collection, analysis and interpretation; in writing of the manuscript; and in the decision to submit the article for publication. Publisher Copyright: {\textcopyright} 2021 Elsevier Inc.",

year = "2021",

month = jun,

doi = "10.1016/j.envres.2021.111075",

language = "English (US)",

volume = "197",

journal = "Environmental Research",

issn = "0013-9351",

publisher = "Academic Press Inc.",

}

TY - JOUR

T1 - The relationship between traffic-related air pollution exposures and allostatic load score among youth with type 1 diabetes in the SEARCH cohort

AU - Montresor-López, Jessica A.

AU - Reading, Stephanie R.

AU - Yanosky, Jeffrey D.

AU - Mittleman, Murray A.

AU - Bell, Ronny A.

AU - Crume, Tessa L.

AU - Dabelea, Dana

AU - Dolan, Lawrence

AU - D'Agostino, Ralph B.

AU - Marcovina, Santica M.

AU - Pihoker, Catherine

AU - Reynolds, Kristi

AU - Urbina, Elaine

AU - Liese, Angela D.

AU - Quirós-Alcalá, Lesliam

AU - Smith, J. Carson

AU - Bueno de Mesquita, P. Jacob

AU - Puett, Robin C.

N1 - Funding Information: Funding for the SEARCH Air Ancillary Study is from the National Institutes of Health , National Institute of Environmental Health Sciences (grant number R01 ES019168 ). The SEARCH for Diabetes in Youth Study is funded by the Centers for Disease Control and Prevention (PA numbers 00097 , DP-05-069 , and DP-10-001 ) and additionally supported by the National Institute of Diabetes and Digestive and Kidney Diseases . Support was also provided by the South Carolina Clinical & Translational Research Institute at the Medical University of South Carolina (NIH/ National Center for Advancing Translational Sciences ( NCATS ) grant number UL1 TR000062 ); Seattle Children’s Hospital and the University of Washington (NIH/ NCATS grant number UL1 TR00423 ); University of Colorado Pediatric Clinical and Translational Research Center (NIH/ NCATS grant Number UL1 TR000154 ); the Barbara Davis Center at the University of Colorado Denver (DERC NIH grant number P30 DK57516 ); the University of Cincinnati (NIH/NCATS grant number UL1 TR000077 ); and the Children with Medical Handicaps program managed by the Ohio Department of Health . The sponsors had no involvement in study design; in data collection, analysis and interpretation; in writing of the manuscript; and in the decision to submit the article for publication. Funding Information: Funding for the SEARCH Air Ancillary Study is from the National Institutes of Health, National Institute of Environmental Health Sciences grant R01 ES019168. The SEARCH for Diabetes in Youth Study is funded by the Centers for Disease Control and Prevention (PA numbers 00097, DP-05-069, and DP-10-001) and additionally supported by the National Institute of Diabetes and Digestive and Kidney Diseases. Support was also provided by the South Carolina Clinical & Translational Research Institute at the Medical University of South Carolina, NIH/National Center for Advancing Translational Sciences (NCATS) grant number UL1 TR000062; Seattle Children's Hospital and the University of Washington, NIH/NCATS grant number UL1 TR00423; University of Colorado Pediatric Clinical and Translational Research Center, NIH/NCATS grant Number UL1 TR000154; the Barbara Davis Center at the University of Colorado at Denver (DERC NIH grant number P30 DK57516); the University of Cincinnati, NIH/NCATS grant number UL1 TR000077; and the Children with Medical Handicaps program managed by the Ohio Department of Health. The sponsors had no involvement in study design; in data collection, analysis and interpretation; in writing of the manuscript; and in the decision to submit the article for publication.The authors graciously thank everyone involved with the SEARCH for Diabetes in Youth study ? including participants and their families, as well as health care providers ? without whom this study would not have been possible. The authors also thank James Hibbert, University of South Carolina, for geocoding addresses, and Verada Shevade, University of Maryland, for assisting with formatting. Funding for the SEARCH Air Ancillary Study is from the National Institutes of Health, National Institute of Environmental Health Sciences (grant number R01 ES019168). The SEARCH for Diabetes in Youth Study is funded by the Centers for Disease Control and Prevention (PA numbers 00097, DP-05-069, and DP-10-001) and additionally supported by the National Institute of Diabetes and Digestive and Kidney Diseases. Support was also provided by the South Carolina Clinical & Translational Research Institute at the Medical University of South Carolina (NIH/National Center for Advancing Translational Sciences (NCATS) grant number UL1 TR000062); Seattle Children's Hospital and the University of Washington (NIH/NCATS grant number UL1 TR00423); University of Colorado Pediatric Clinical and Translational Research Center (NIH/NCATS grant Number UL1 TR000154); the Barbara Davis Center at the University of Colorado Denver (DERC NIH grant number P30 DK57516); the University of Cincinnati (NIH/NCATS grant number UL1 TR000077); and the Children with Medical Handicaps program managed by the Ohio Department of Health. The sponsors had no involvement in study design; in data collection, analysis and interpretation; in writing of the manuscript; and in the decision to submit the article for publication. Contract numbers for SEARCH sites include: Kaiser Permanente Southern California (U18DP006133, U48/CCU919219, U01 DP000246, and U18DP002714), University of Colorado Denver (U18DP006139, U48/CCU819241-3, U01 DP000247, and U18DP000247-06A1), Children's Hospital Medical Center (Cincinnati) (U18DP006134, U48/CCU519239, U01 DP000248, and 1U18DP002709), University of North Carolina at Chapel Hill (U18DP006138, U48/CCU419249, U01 DP000254, and U18DP002708), Seattle Children's Hospital (U18DP006136, U58/CCU019235-4, U01 DP000244, and U18DP002710-01), Wake Forest University School of Medicine (U18DP006131, U48/CCU919219, U01 DP000250, and 200-2010-35171). The SEARCH writing group for this manuscript included J.M. (vice chair), S.R. J.Y. R.B. T.C. L.D. R.D. C.P. K.R. A.L. and R.P (chair). J.M. developed the concept for the manuscript, analyzed data, and wrote the manuscript. S.R. and K.R. contributed to the development of the AL index and reviewed/edited the manuscript. J.Y. developed the exposure models, contributed to the methods, and reviewed/edited the manuscript. M.M. provided epidemiological expertise and reviewed/edited the manuscript. R.D. provided statistical expertise and assisted with analysis. R.B. T.C. D.D, L.D, S.M. C.P. P.J.B. and J.S. reviewed/edited the manuscript. E.U. provided medical expertise related to the biomarkers in the AL score and reviewed/edited the manuscript. A.L. contributed to the development of the manuscript and reviewed/edited. L.Q. assisted with analysis and reviewed/edited the manuscript. R.P. assisted with the development of the manuscript, contributed to the analysis and discussion, and reviewed/edited. The guarantors are J.M. and R.P. The authors declare no relevant conflicts of interest. Funding Information: Funding for the SEARCH Air Ancillary Study is from the National Institutes of Health , National Institute of Environmental Health Sciences grant R01 ES019168 . The SEARCH for Diabetes in Youth Study is funded by the Centers for Disease Control and Prevention (PA numbers 00097 , DP-05-069 , and DP-10-001 ) and additionally supported by the National Institute of Diabetes and Digestive and Kidney Diseases . Support was also provided by the South Carolina Clinical & Translational Research Institute at the Medical University of South Carolina , NIH / National Center for Advancing Translational Sciences ( NCATS ) grant number UL1 TR000062 ; Seattle Children’s Hospital and the University of Washington , NIH / NCATS grant number UL1 TR00423 ; University of Colorado Pediatric Clinical and Translational Research Center , NIH / NCATS grant Number UL1 TR000154 ; the Barbara Davis Center at the University of Colorado at Denver (DERC NIH grant number P30 DK57516 ); the University of Cincinnati , NIH / NCATS grant number UL1 TR000077 ; and the Children with Medical Handicaps program managed by the Ohio Department of Health . The sponsors had no involvement in study design; in data collection, analysis and interpretation; in writing of the manuscript; and in the decision to submit the article for publication. Publisher Copyright: © 2021 Elsevier Inc.

PY - 2021/6

Y1 - 2021/6

N2 - Objective: We investigated the effects of chronic exposures to particulate and traffic-related air pollution on allostatic load (AL) score, a marker of cumulative biological risk, among youth with type 1 diabetes. Research design and methods: Participants were drawn from five clinical sites of the SEARCH for Diabetes in Youth (SEARCH) study (n = 2338). Baseline questionnaires, anthropometric measures, and a fasting blood test were taken at a clinic visit between 2001 and 2005. AL was operationalized using 10 biomarkers reflecting cardiovascular, metabolic, and inflammatory risk. Annual residential exposures to PM2.5 and proximity to heavily-trafficked major roadways were estimated for each participant. Poisson regression models adjusted for sociodemographic and lifestyle factors were conducted for each exposure. Results: No significant associations were observed between exposures to PM2.5 or proximity to traffic and AL score, however analyses were suggestive of effect modification by race for residential distance to heavily-trafficked major roadways (p = 0.02). In stratified analyses, residing <100, 100-<200 and 200-<400 m compared to 400 m or more from heavily-trafficked major roadways was associated with 11%, 26% and 14% increases in AL score, respectively (95% CIs: -4, 29; 9, 45; −1, 30) for non-white participants compared to 6%, −2%, and −2% changes (95% CIs: -2, 15; −10, 7; −8, 6) for white participants. Conclusions: Among this population of youth with type 1 diabetes, we did not observe consistent relationships between chronic exposures to particulate and traffic-related air pollution and changes in AL score, however associations for traffic-related pollution exposures may differ by race/ethnicity and warrant further examination.

AB - Objective: We investigated the effects of chronic exposures to particulate and traffic-related air pollution on allostatic load (AL) score, a marker of cumulative biological risk, among youth with type 1 diabetes. Research design and methods: Participants were drawn from five clinical sites of the SEARCH for Diabetes in Youth (SEARCH) study (n = 2338). Baseline questionnaires, anthropometric measures, and a fasting blood test were taken at a clinic visit between 2001 and 2005. AL was operationalized using 10 biomarkers reflecting cardiovascular, metabolic, and inflammatory risk. Annual residential exposures to PM2.5 and proximity to heavily-trafficked major roadways were estimated for each participant. Poisson regression models adjusted for sociodemographic and lifestyle factors were conducted for each exposure. Results: No significant associations were observed between exposures to PM2.5 or proximity to traffic and AL score, however analyses were suggestive of effect modification by race for residential distance to heavily-trafficked major roadways (p = 0.02). In stratified analyses, residing <100, 100-<200 and 200-<400 m compared to 400 m or more from heavily-trafficked major roadways was associated with 11%, 26% and 14% increases in AL score, respectively (95% CIs: -4, 29; 9, 45; −1, 30) for non-white participants compared to 6%, −2%, and −2% changes (95% CIs: -2, 15; −10, 7; −8, 6) for white participants. Conclusions: Among this population of youth with type 1 diabetes, we did not observe consistent relationships between chronic exposures to particulate and traffic-related air pollution and changes in AL score, however associations for traffic-related pollution exposures may differ by race/ethnicity and warrant further examination.

KW - Air pollution

KW - Allostatic load

KW - Chronic exposure

KW - Type 1 diabetes

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U2 - 10.1016/j.envres.2021.111075

DO - 10.1016/j.envres.2021.111075

M3 - Article

C2 - 33798519

AN - SCOPUS:85104144135

VL - 197

JO - Environmental Research

JF - Environmental Research

SN - 0013-9351

M1 - 111075

ER -

The relationship between traffic-related air pollution exposures and allostatic load score among youth with type 1 diabetes in the SEARCH cohort

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