The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; Clinical Trials and Biostatistics Laboratory, Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China; Centre for Health Systems and Policy Research, The Chinese University of Hong Kong, Hong Kong, China.
The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; Centre for Health Systems and Policy Research, The Chinese University of Hong Kong, Hong Kong, China.
Sci Total Environ. 2022 Sep 1;837:155711. doi: 10.1016/j.scitotenv.2022.155711. Epub 2022 May 4.
While influenza infections and environmental factors have been documented as potential drivers of tuberculosis, no investigations have simultaneously examined their impact on tuberculosis at a population level. This study thereby made use of Hong Kong's surveillance data over 22 years to elucidate the temporal association between environmental influences, influenza infections, and tuberculosis activity.
Weekly total numbers of hospital admissions due to tuberculosis, meteorological data, and outdoor air pollutant concentrations in Hong Kong during 1998-2019 were obtained. All-type influenza-like illness positive (ILI+) rate and type-specific ILI+ rates were used as proxies for influenza activity. Quasi-Poisson generalized additive models together with distributed lag non-linear models were used to assess the association of interest.
A total of 164,116 hospital admissions due to tuberculosis were notified in public settings over a period of 22 years. The cumulative adjusted relative risk (ARR) of hospital admission due to tuberculosis was 1.07 (95% CI, 1.00-1.14) when the mean ambient temperature increased from 15.1 °C (the 5th percentile) to 24.5 °C (median). Short-term exposure to air pollutants was not found to be statistically significantly related to tuberculosis hospitalization. Accounting for the environmental covariates in the analysis, the cumulative ARR of tuberculosis admission was elevated to 1.05 (95% CI, 1.01-1.08) when the rate of ILI+ total increased from zero to 19.9 per 1000 consultations, the 95th percentile.
Our findings demonstrated that increased influenza activity and higher temperature were related to a higher risk of tuberculosis admissions. Stepping up the promotion of influenza vaccination, especially before the summer season, may lower the risk of tuberculosis infection/reactivation for vulnerable groups (e.g. elderly born before the launch of Bacillus Calmette-Guérin vaccination programme).
流感感染和环境因素已被证实是结核病的潜在驱动因素，但尚无研究同时在人群水平上考察它们对结核病的影响。本研究利用香港 22 年的监测数据，阐明了环境影响、流感感染与结核病活动之间的时间关联。
获取了 1998-2019 年期间香港每周因结核病住院的总人数、气象数据和室外空气污染物浓度。所有类型流感样疾病阳性（ILI+）率和特定类型 ILI+率被用作流感活动的替代指标。使用拟泊松广义加性模型和分布式滞后非线性模型评估相关关联。
在 22 年期间，共报告了 164116 例在公共环境中发生的结核病住院病例。当环境温度从 15.1°C（第 5 百分位数）升高至 24.5°C（中位数）时，结核病住院的累积调整相对风险（ARR）为 1.07（95%CI，1.00-1.14）。短期暴露于空气污染物与结核病住院无统计学显著相关性。在分析中考虑环境协变量时，当 ILI+总人数从 0 增加到 19.9/1000 次就诊（第 95 百分位数）时，结核病住院的累积 ARR 升高至 1.05（95%CI，1.01-1.08）。
我们的研究结果表明，流感活动增加和气温升高与结核病住院风险增加相关。加强流感疫苗接种的推广，特别是在夏季之前，可能会降低弱势群体（如卡介苗接种计划启动前出生的老年人）感染/再激活结核病的风险。
