Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China.
Department of Occupational Health and Environmental Health, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China.
Environ Res. 2020 May;184:109343. doi: 10.1016/j.envres.2020.109343. Epub 2020 Mar 3.
The current evidence has presented mixed results between air pollutants exposure and the progression of tuberculosis (TB). The purpose of this study was to explore the association between short-term exposure to air pollutants and the risk of TB outpatient visits in Hefei, China.
Time-series analysis was used to assess the effect of short-term exposure to ambient air pollutants on the risk of TB outpatient visits. A Poisson generalized linear regression model combined with a distributed lag non-linear model (DLNM) was applied to explore the association. The effects of different gender (male, female), age (≤65 years old, >65 years old) and season (cold season, warm season) on the risk of TB were investigated by stratified analysis. Sensitivity analyses were conducted to test the robustness of our findings.
A total of 22,749 active TB cases were identified from November 1, 2013 to December 31, 2018 in Hefei. The overall exposure-response curve showed that the concentration of particulate matter with aerodynamic diameter less than 2.5 μm (PM) and nitrogen dioxide (NO) exposure were positively correlated with the risk of TB outpatient visits, while ozone (O) and sulfur dioxide (SO) exposure were negatively correlated with the risk of TB outpatient visits. The maximum lag-specific and cumulative relative risk (RR) of TB outpatient visits were 1.057 [95%CI: 1.002-1.115, lag 3 day] and 1.559 (95%CI: 1.057-2.300, lag 13 days) for each 10 μg/m³ increase in PM; 1.026 (95% CI: 1.008-1.044, lag 0 day) and 1.559 (95%CI: 1.057-2.300, lag 07 days) for each 10 μg/m³ increase in NO; 0.866 (95% CI: 0.801-0.935, lag 5 day) and 0.852 (95%CI: 1.01-1.11, lag 0-14 days) for each 10 μg/m³ increase in SO in the single-pollutant model. There was only a negative association between O exposure and the cumulative risk of TB outpatient visits (RR = 0.960, 95%CI: 0.936-0.984, lag 07 days). Stratified analyses showed that the effects of SO and O exposure were different between warm and cold seasons. The effect of NO exposure remained statistically significant in male, younger, and cold season subgroups. Besides, elderly people are more susceptible to PM exposure.
This study suggests that exposure to PM, NO, SO, and O are associated with the risk of TB outpatient visits. Seasonal variation may have a greater impact on the risk of TB outpatient visits compared with gender and age.
目前的证据表明，空气污染暴露与结核病（TB）的进展之间存在混合结果。本研究旨在探讨短期暴露于空气污染物与中国合肥结核病门诊就诊风险之间的关系。
采用时间序列分析评估环境空气污染物短期暴露对结核病门诊就诊风险的影响。应用泊松广义线性回归模型结合分布式滞后非线性模型（DLNM）探讨关联。通过分层分析研究不同性别（男性、女性）、年龄（≤65 岁、>65 岁）和季节（冷季、暖季）对结核病发病风险的影响。进行敏感性分析以检验研究结果的稳健性。
2013 年 11 月 1 日至 2018 年 12 月 31 日期间，在合肥市共确定了 22749 例活动性结核病病例。总体暴露反应曲线显示，颗粒物（PM）和二氧化氮（NO）浓度暴露与结核病门诊就诊风险呈正相关，而臭氧（O）和二氧化硫（SO）浓度暴露与结核病门诊就诊风险呈负相关。TB 门诊就诊风险的最大滞后特异性和累积相对风险（RR）分别为 1.057 [95%CI：1.002-1.115，滞后 3 天]和 1.559（95%CI：1.057-2.300，滞后 13 天），每增加 10μg/m³ PM；1.026（95% CI：1.008-1.044，滞后 0 天）和 1.559（95%CI：1.057-2.300，滞后 07 天）每增加 10μg/m³ NO；0.866（95% CI：0.801-0.935，滞后 5 天）和 0.852（95%CI：1.01-1.11，滞后 0-14 天），每增加 10μg/m³ SO 在单污染物模型中。SO 和 O 暴露与 TB 门诊就诊的累积风险仅呈负相关（RR=0.960，95%CI：0.936-0.984，滞后 07 天）。分层分析表明，SO 和 O 暴露的季节变化对 TB 门诊就诊风险的影响不同。NO 暴露在男性、年轻和冷季亚组中的作用仍具有统计学意义。此外，老年人更容易受到 PM 暴露的影响。
本研究表明，PM、NO、SO 和 O 的暴露与结核病门诊就诊风险相关。与性别和年龄相比，季节变化可能对结核病门诊就诊风险的影响更大。
