Department of Medical Statistics, School of Public Health & Center for Health Information Research & Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China.
Department of Medical Statistics, School of Public Health & Center for Health Information Research & Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China.
Sci Total Environ. 2023 Apr 20;870:161745. doi: 10.1016/j.scitotenv.2023.161745. Epub 2023 Jan 21.
We aimed to estimate the causal impacts of long-term exposure to major PM components - including black carbon, organic matter, sulfate, nitrate, and ammonium - on the incidence and mortality of tuberculosis in China.
We collected annual and provincial-level tuberculosis incidence and mortality, concentrations of PM components, and socioeconomic indicators from between 2004 and 2018 in mainland China. We used the difference-in-differences (DID) causal inference approach with a generalized weighted quantile sum (gWQS) regression model to estimate the long-term effects and relative contributions of PM components' exposure on tuberculosis incidence and mortality.
We found that long-term multi-components exposure was significantly associated with tuberculosis incidence (WQS index IR%:8.34 %, 95 % CI:4.54 %-12.27 %) and mortality (WQS index IR%:19.49 %, 95 % CI: 9.72 %-30.13 %). Primary pollutants, black carbon and organic matter, contributed most of the overall mixture effect (over 85 %). Nitrate showed a critical role in tuberculosis burden in not-aging provinces and in regions at the Q3 stratum (i.e., the 3rd quartile) of GDP per capita and urbanization rate. Meanwhile the contribution of sulfate to tuberculosis burden in regions at the Q1 stratum of GDP per capita and urbanization rate was the largest among the effect of secondary pollutants (i.e., sulfate, nitrate, and ammonium).
The mitigation of black carbon and organic matter pollution may significantly reduce the tuberculosis burden in China. Controlling nitrate emissions and increasing clean energy (i.e., energy sources with limited pollution emissions, such as natural gas and clean coal) may also be effective in certain regions.
本研究旨在评估长期暴露于主要 PM 成分（包括黑碳、有机物、硫酸盐、硝酸盐和铵盐）对中国结核病发病和死亡的因果影响。
我们收集了 2004 年至 2018 年中国大陆地区的结核病发病率和死亡率、PM 成分浓度和社会经济指标的年度和省级数据。我们采用了广义加权和（gWQS）回归模型的差分法（DID）因果推断方法来估计 PM 成分暴露对结核病发病和死亡的长期影响和相对贡献。
我们发现，长期多成分暴露与结核病发病率（WQS 指数 IR%：8.34%，95%CI：4.54%-12.27%）和死亡率（WQS 指数 IR%：19.49%，95%CI：9.72%-30.13%）显著相关。主要污染物黑碳和有机物对总混合物效应的贡献最大（超过 85%）。硝酸盐在非老龄化省份和人均 GDP 与城市化率处于 Q3 分位（即第三四分位数）的地区对结核病负担具有关键作用。而在人均 GDP 和城市化率处于 Q1 分位的地区，硫酸盐对结核病负担的贡献在二次污染物（即硫酸盐、硝酸盐和铵盐）中最大。
减少黑碳和有机物污染可能会显著降低中国的结核病负担。控制硝酸盐排放和增加清洁能源（即排放污染有限的能源，如天然气和清洁煤）在某些地区也可能有效。
