Xie Bo, Wu Maolin, Pang Zhe, Chen Bin
School of Urban Design, Wuhan University.
Zhejiang Provincial Center for Disease Control and Prevention.
Environ Health Prev Med. 2025;30:31. doi: 10.1265/ehpm.24-00381.
Evidence on the combined effects of air pollutants and greenspace exposure on pulmonary tuberculosis (PTB) treatment is limited, particularly in developing countries with high levels of air pollution.
We aimed to examine the individual and combined effects of long-term exposure to air pollutants on PTB treatment outcomes while also investigating the potential modifying effect of greenspace.
This population-based study included 82,784 PTB cases notified in Zhejiang Province, China, from 2015 to 2019. The 24-month average concentrations of particulate matter with an aerodynamic diameter ≤2.5 µm (PM), ozone (O), nitrogen dioxide (NO), and sulfur dioxide (SO) before PTB diagnosis were estimated using a dataset derived from satellite-based machine learning models and monitoring stations. Greenspace exposure was assessed using the annual China Land Cover Dataset. We conducted analyses using time-varying Cox proportional hazards models and cumulative risk indices.
In individual effect models, each 10 µg/m increase in PM, NO, O, and SO concentrations was associated with hazard ratios for PTB treatment success of 0.95 (95% confidence interval (CI): 0.93-0.97), 0.92 (95% CI: 0.91-0.94), 0.98 (95% CI: 0.97-0.99), and 1.52 (95% CI: 1.49-1.56), respectively. In combined effect models, long-term exposure to the combination of air pollutants was negatively associated with PTB treatment success, with a joint hazard ratio (JHR) of 0.79 (95% CI: 0.63-0.96). Among the pollutants examined, O contributed the most to the increased risks, followed by PM and NO. Additionally, areas with moderate levels of greenspace showed a reduced risk (JHR = 0.81, 95% CI: 0.62-0.98) compared with the estimate from the third quantile model (JHR = 0.68, 95% CI: 0.52-0.83).
Combined air pollutants significantly impede successful PTB treatment outcomes, with O and PM accounting for nearly 75% of this detrimental effect. Moderate levels of greenspace can mitigate the adverse effects associated with combined air pollutants, leading to improved treatment success for patients with PTB.
关于空气污染物和绿地暴露对肺结核（PTB）治疗的综合影响的证据有限，尤其是在空气污染水平较高的发展中国家。
我们旨在研究长期暴露于空气污染物对PTB治疗结果的个体和综合影响，同时调查绿地的潜在调节作用。
这项基于人群的研究纳入了2015年至2019年在中国浙江省报告的82784例PTB病例。使用基于卫星的机器学习模型和监测站的数据集估计PTB诊断前空气动力学直径≤2.5μm的颗粒物（PM）、臭氧（O₃）、二氧化氮（NO₂）和二氧化硫（SO₂）的24个月平均浓度。使用年度中国土地覆盖数据集评估绿地暴露情况。我们使用时变Cox比例风险模型和累积风险指数进行分析。
在个体效应模型中，PM、NO₂、O₃和SO₂浓度每增加10μg/m³，PTB治疗成功的风险比分别为0.95（95%置信区间（CI）：0.93 - 0.97）、0.92（95%CI：0.91 - 0.94）、0.98（95%CI：0.97 - 0.99）和1.52（95%CI：1.49 - 1.56）。在综合效应模型中，长期暴露于空气污染物的组合与PTB治疗成功呈负相关，联合风险比（JHR）为0.79（95%CI：0.63 - 0.96）。在所检查的污染物中，O₃对风险增加的贡献最大，其次是PM和NO₂。此外，与第三分位数模型的估计值（JHR = 0.68，95%CI：0.52 - 0.83）相比，绿地水平中等的地区风险降低（JHR = 0.81，95%CI：0.62 - 0.98）。
空气污染物的组合显著阻碍PTB治疗的成功结果，O₃和PM占这种有害影响的近75%。中等水平的绿地可以减轻与空气污染物组合相关的不利影响，从而提高PTB患者的治疗成功率。
