Center for Tuberculosis Control of Guangdong Province, Guangzhou, China.
Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Canada.
Sci Total Environ. 2024 Oct 10;946:174048. doi: 10.1016/j.scitotenv.2024.174048. Epub 2024 Jun 19.
The association between ambient coarse particulate matter (PM) and mortality in multi-drug resistant tuberculosis (MDR-TB) patients has not yet been studied. The modifying effects of temperature and humidity on this association are completely unknown.
To evaluate the effects of long-term PM exposures, and their modifications by temperature and humidity on mortality among MDR-TB patients.
A Chinese cohort of 3469 MDR-TB patients was followed up from diagnosis until death, loss to follow-up, or the study's end, averaging 2567 days per patient. PM concentrations were derived from the difference between PM and PM. Cox proportional hazard models estimated hazard ratios (HRs) per 3.74 μg/m (interquartile range, IQR) exposure to PM and all-cause mortality for the full cohort and individuals at distinct long-term and short-term temperature and humidity levels, adjusting for other air pollutants and potential covariates. Exposure-response relationships were quantified using smoothed splines.
Hazard ratios of 1.733 (95% CI, 1.407, 2.135) and 1.427 (1.114, 1.827) were observed for mortality in association with PM exposures for the full cohort under both long-term and short-term exposures to temperature and humidity. Modifying effects by temperature and humidity were heterogenous across sexes, age, treatment history, and surrounding environment measured by greenness and nighttime light levels. Nonlinear exposure-response curves suggestes a cumulative risk of PM-related mortality starting from a low exposure concentration around 15 μg/m.
Long-term exposure to PM poses significant harm among MDR-TB patients, with effects modified by temperature and humidity. Immediate surveillance of PM is crucial to mitigate the progression of MDR-TB severity, particularly due to co-exposures to air pollution and adverse weather conditions.
大气粗颗粒物（PM）与耐多药结核病（MDR-TB）患者死亡率之间的关系尚未得到研究。温度和湿度对此关联的影响尚完全未知。
评估长期 PM 暴露及其与温度和湿度的相互作用对 MDR-TB 患者死亡率的影响。
对中国的 3469 名 MDR-TB 患者进行了队列研究，随访时间从诊断开始，直到患者死亡、失访或研究结束，平均每位患者随访 2567 天。通过 PM 与 PM 之间的差值来推算 PM 浓度。Cox 比例风险模型估计了 PM 每增加 3.74μg/m（四分位距，IQR）与全队列以及不同长期和短期温度和湿度水平个体的全因死亡率之间的风险比（HR），并针对其他空气污染物和潜在协变量进行了调整。使用平滑样条来量化暴露-反应关系。
在长期和短期温度和湿度暴露下，全队列中 PM 暴露与死亡率之间的 HR 分别为 1.733（95%CI，1.407，2.135）和 1.427（1.114，1.827）。温度和湿度的调节作用在性别、年龄、治疗史以及通过绿化和夜间灯光水平测量的周围环境等方面存在异质性。非线性暴露-反应曲线表明，PM 相关死亡率的累积风险始于 15μg/m 左右的低暴露浓度。
长期暴露于 PM 对 MDR-TB 患者造成严重危害，其影响受温度和湿度调节。对 PM 的即时监测对于减轻 MDR-TB 严重程度的进展至关重要，特别是由于空气污染和不利天气条件的共同暴露。
