Abstract
Tuberculosis (TB) has a very high mortality rate worldwide. However, only a few studies have examined the associations between short-term exposure to air pollution and TB incidence. Our objectives were to estimate associations between short-term exposure to air pollutants and TB incidence in Wuhan city, China, during the 2015–2016 period. We applied a generalized additive model to access the short-term association of air pollution with TB. Daily exposure to each air pollutant in Wuhan was determined using ordinary kriging. The air pollutants included in the analysis were particulate matter (PM) with an aerodynamic diameter less than or equal to 2.5 micrometers (PM2.5), PM with an aerodynamic diameter less than or equal to 10 micrometers (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), and ground-level ozone (O3). Daily incident cases of TB were obtained from the Hubei Provincial Center for Disease Control and Prevention (Hubei CDC). Both single- and multiple-pollutant models were used to examine the associations between air pollution and TB. Seasonal variation was assessed by splitting the all-year data into warm (May–October) and cold (November–April) seasons. In the single-pollutant model, for a 10 μg/m3 increase in PM2.5, PM10, and O3 at lag 7, the associated TB risk increased by 17.03% (95% CI: 6.39, 28.74), 11.08% (95% CI: 6.39, 28.74), and 16.15% (95% CI: 1.88, 32.42), respectively. In the multi-pollutant model, the effect of PM2.5 on TB remained statistically significant, while the effects of other pollutants were attenuated. The seasonal analysis showed that there was not much difference regarding the impact of air pollution on TB between the warm season and the cold season. Our study reveals that the mechanism linking air pollution and TB is still complex. Further research is warranted to explore the interaction of air pollution and TB.
Highlights
Tuberculosis (TB) is one of the top ten deadly diseases in the world [1]
There were 12,648 incident cases of TB included in our analysis during this two-year study
Air pollutant data were close to completeness, with only 9 days missing
Summary
Tuberculosis (TB) is one of the top ten deadly diseases in the world [1]. In 2016, there were about10.4 million people diagnosed with TB worldwide, and 1.7 million people died from the disease [1].Seven developing countries, China, India, Indonesia, Nigeria, the Philippines, Pakistan, and SouthAfrica, account for 64% of the total cases [1]. As one of the countries with the highest number of TB cases, China has been working hard to lower the incidence of TB and has successfully reduced the TB-related mortality by 80% from 1990 to 2010 [2]. Despite this progress, China still has an estimated 1 million new cases each year [3] and faces serious drug-resistant TB epidemics [4]. In Hubei Province where Wuhan is located, the reported incidence of TB in 2017 was 68.3/100,000, ranking ninth in the nation [5]. As the capital of Hubei Province and the largest city in central China, Wuhan has a high incidence of TB
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