Abstract
Few epidemiological studies have evaluated the effects of air pollution on the risk of pulmonary tuberculosis (TB). We investigated the associations of ambient air pollutants (particulate matter with aerodynamic diameter <2.5 μm (PM2.5), sulfur dioxide (SO2),nitrogen dioxide (NO2), ozone (O3), and carbon monoxide (CO)) in relation to the risk of pulmonary TB in a cohort of Chinese TB patient in Jinan city from 2011 to 2015. A total of 9344 newly diagnosed pulmonary TB cases were included. Poisson regression model was employed to estimate the risk of air pollution and daily diagnosed pulmonary TB. Four different air pollution exposure windows (3, 6, 9, and 12 months) before TB diagnoses were calculated from the daily concentration of air pollution. In overall analysis, we did not find strong evidence for an association between continuous exposures to most ambient air pollutants and risk for pulmonary TB. However, in categorical analysis, we observed statistically significant overall associations between pulmonary TB risk and PM2.5 (3 month exposure window: RR = 1.228, 95%CI: 1.091–1.381) as well as CO (3 month exposure window: RR = 1.169, 95%CI: 1.028–1.329; 9 month exposure window: RR = 1.442, 95%CI: 1.028–2.024) exposures. Moreover, subgroup analyses suggested that most of the air pollutants (PM2.5, SO2, O3, and CO) were significantly associated with increased risk of TB among the males, the females, the <60 years, and the smear negative cases. The dominant statistically significant associations were detected at 3-month exposure window of air pollution before the diagnosis of TB. Our results detected positive associations between ambient PM2.5, CO exposures and the risk of newly diagnosed pulmonary TB in China. The suggestive evidence that the 3 month air pollution exposure window was associated with increased TB risk warrants further investigation.
Highlights
The health effects of severe air pollution have attracted increasing concern in China, partly due to the increasing number of days with very high levels of air pollution
We identified a total of 9344 newly diagnosed cases of pulmonary TB in Jinan city during the study period from 2011 to 2015
For SO2, exposure to middle-level SO2 was associated with an increased risk of newly diagnosed TB among the smear negative cases (RR = 1.353, 95% confidence intervals (CIs): 1.096–1.670) but not among smear positive TB cases at the 6-month exposure window
Summary
The health effects of severe air pollution have attracted increasing concern in China, partly due to the increasing number of days with very high levels of air pollution. A recent nested case-control study showed that monoxide (CO) and nitrogen dioxide (NO2) are associated with increased risk of pulmonary TB among residents in Northern California, but no positive associations between PM with aerodynamic diameter
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