Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China.
Department of Biostatistics, School of Public Health, Shandong University, Jinan, Shandong, China; Jinan Municipal Center for Disease Control and Prevention, Jinan, Shandong, China.
Sci Rep. 2018 Nov 27;8(1):17411. doi: 10.1038/s41598-018-35411-6.
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 (PM), sulfur dioxide (SO),nitrogen dioxide (NO), ozone (O), 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 PM (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 (PM, SO, O, 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 PM, 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.
很少有流行病学研究评估空气污染对肺结核（TB）风险的影响。我们调查了 2011 年至 2015 年济南地区中国 TB 患者队列中环境空气污染物（空气动力学直径<2.5μm 的颗粒物（PM）、二氧化硫（SO）、二氧化氮（NO）、臭氧（O）和一氧化碳（CO））与肺结核风险之间的关联。共纳入 9344 例新发肺结核病例。采用泊松回归模型估计空气污染和每日诊断肺结核的风险。从每日空气污染浓度计算了 TB 诊断前 3、6、9 和 12 个月的四个不同的空气污染暴露窗口。在总体分析中，我们没有发现大多数环境空气污染物连续暴露与肺结核风险之间存在强关联的证据。然而，在分类分析中，我们观察到肺结核风险与 PM（3 个月暴露窗口：RR=1.228，95%CI：1.091-1.381）以及 CO（3 个月暴露窗口：RR=1.169，95%CI：1.028-1.329；9 个月暴露窗口：RR=1.442，95%CI：1.028-2.024）暴露之间存在统计学上显著的总体关联。此外，亚组分析表明，大多数空气污染物（PM、SO、O 和 CO）与男性、女性、<60 岁和痰涂片阴性病例的 TB 风险增加显著相关。在 TB 诊断前的空气污染 3 个月暴露窗口中检测到主要的统计学显著关联。我们的研究结果在中国检测到环境 PM 和 CO 暴露与新诊断肺结核风险之间存在正相关。空气污染 3 个月暴露窗口与 TB 风险增加相关的提示性证据需要进一步研究。
