Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwuweiqi Road, Jinan, 250021, Shandong, China.
Department of Applied Mathematics, Hong Kong Polytechnic University, Hung Hom, Hong Kong, SAR, China.
Environ Sci Pollut Res Int. 2021 Jun;28(22):27757-27768. doi: 10.1007/s11356-021-12621-6. Epub 2021 Jan 30.
Few studies conducted in China have assessed the effects of ambient air pollution exposure on tuberculosis (TB) risk and mortality, especially with a multicity setting. We evaluated the effect of short- and long-term ambient sulfur dioxide (SO), nitrogen dioxide (NO), carbon monoxide (CO), ozone (O), and particulate matter≤2.5 μm in aerodynamic diameter (PM) exposures on development and mortality of active TB in 7 Chinese cities in Shandong province from January 1, 2013, to December 31, 2017. We estimated the pollution-associated risk to new infection TB, recurrent TB, and mortality in relation to 1-μg/m increases in air pollutants using the penalized multivariate Poisson regression models. A total of 83,555 new infective TB and 3060 recurrent TB including 997 deaths were recorded. Short- and long-term exposures to outdoor air pollutants (SO, NO, CO, O, and PM) were significantly associated with new infection TB, recurrent TB risk, and mortality. The dominant positive effects of SO, NO, CO, and PM for new infection and recurrent TB risk were observed at long-term (>30 days) exposure, whereas the dominant effects of SO, CO, and PM for mortality were observed at short-term (≤30 days) exposures. Of the 5 air pollutants we assessed, SO and PM exhibited more consistent and strong associations with TB-related outcomes. We estimated an increase of 1.33% (95% CI 1.29%, 1.37%) and 3.04% (95% CI 2.98%, 3.11%) in new infection TB count for each 1-μg/m increase of SO at lag 0-180 days and PM at lag 0-365 days, respectively. This epidemiologic study in China shows that air pollution exposure is associated with increased risk of active TB development and mortality. The control of ambient air pollution may benefit the control and decrease the mortality of TB disease.
在中国，很少有研究评估大气污染暴露对结核病（TB）风险和死亡率的影响，尤其是在多城市环境下。我们评估了短期和长期暴露于大气二氧化硫（SO）、二氧化氮（NO）、一氧化碳（CO）、臭氧（O）和空气动力学直径≤2.5μm 的颗粒物（PM）对 2013 年 1 月 1 日至 2017 年 12 月 31 日山东省 7 个城市活动性肺结核发展和死亡的影响。我们使用惩罚多元泊松回归模型，估计了与每增加 1μg/m3 空气污染物相关的新感染性肺结核、复发性肺结核和死亡率的污染相关风险。共记录了 83555 例新发感染性肺结核和 3060 例复发性肺结核，包括 997 例死亡。短期和长期暴露于室外空气污染物（SO、NO、CO、O 和 PM）与新感染性肺结核、复发性肺结核的风险和死亡率显著相关。SO、NO、CO 和 PM 对新感染和复发性肺结核风险的主要正向影响见于长期（>30 天）暴露，而 SO、CO 和 PM 对死亡率的主要影响见于短期（≤30 天）暴露。在我们评估的 5 种空气污染物中，SO 和 PM 与结核病相关结局的相关性更为一致和强烈。我们估计，SO 在滞后 0-180 天每增加 1μg/m3，新感染性肺结核病例数增加 1.33%（95%CI 1.29%，1.37%），PM 在滞后 0-365 天每增加 1μg/m3，新感染性肺结核病例数增加 3.04%（95%CI 2.98%，3.11%）。这项在中国开展的流行病学研究表明，空气污染暴露与活动性肺结核发展和死亡率的增加相关。控制环境空气污染可能有益于结核病的控制和降低死亡率。
