Impact of gaseous air pollutants on the risk of incident active pulmonary tuberculosis among rural people with latent tuberculosis infection

doi:10.19982/j.issn.1000-6621.20240061

Abstract

Abstract:

Objective: To investigate the influence of primary atmospheric gaseous pollutants on the incidence of active pulmonary tuberculosis among adults in rural areas with latent tuberculosis infection (LTBI). Methods: This study utilized a multicenter, longitudinal cohort of rural residents with LTBI (LATENTTB-NSTM), spanning from 2013 to 2018, comprising 3866 participants who were monitored quarterly over five years to document new cases of active pulmonary tuberculosis. Concentrations of atmospheric gaseous pollutants such as sulfur dioxide (SO₂), nitrogen dioxide (NO₂), ozone (O₃), and carbon monoxide (CO) were precisely matched to the residential locations and periods under review. The association between exposure levels and the emergence of active tuberculosis was analyzed using time-dependent Cox proportional hazards models, stratified by age, sex, educational attainment, family income, and lifestyle factors. Results: Among 3866 individuals diagnosed with latent tuberculosis infection, surveillance identified 58 new cases of active pulmonary tuberculosis. Incremental exposures to SO₂ and CO by 10 μg/m³ and 100 μg/m³, respectively, over a six-month period were associated with a respective 81.0% (HR=1.810, 95%CI: 1.153-2.843) and 19.6% (HR=1.196, 95%CI: 1.031-1.388) increase in the risk of developing active tuberculosis. Notably, these associations appeared more pronounced among older adults and smokers, though the differences did not reach statistical significance (interaction P-values >0.05). Conclusion: Exposure to atmospheric gaseous pollutants, particularly SO₂ and CO, is associated with a heightened risk of developing active pulmonary tuberculosis among individuals with LTBI in rural settings. The management of air quality, therefore, plays a crucial role in the strategic control of tuberculosis.

Key words: Tuberculosis, pulmonary, Infection, Air pollutants, Factor analysis, statistical

CLC Number:

R521

Tian Sifan, Guo Tonglei, Chen Chen, Zhang Bin, Xin Henan, Du Jiang, Cao Xuefang, Feng Boxuan, He Yijun, He Yongpeng, Wang Dakuan, Liu Zisen, Yan Jiaoxia, Shen Lingyu, Di Yuanzhi, Chen Yanxiao, Jin Qi, Duan Weitao, Gao Lei, Gao Xu. Impact of gaseous air pollutants on the risk of incident active pulmonary tuberculosis among rural people with latent tuberculosis infection[J]. Chinese Journal of Antituberculosis, 2024, 46(6): 654-663. doi: 10.19982/j.issn.1000-6621.20240061

Figures/Tables 5

特征	合计 (3866例)	未发生肺结核 (3808例)	发生肺结核 (58例)	统计检验值	P值
年龄(岁,$\bar{x}±s$)	55.2±13.8	55.1±13.8	58.2±16.4	t=-1.433	0.157
年龄组[例(构成比,%)]				χ²=4.276	0.118
18~44岁	889(23.0)	877(23.0)	12(20.7)
45~59岁	1470(38.0)	1454(38.2)	16(27.6)
≥60岁	1507(39.0)	1477(38.8)	30(51.7)
性别[例(构成比,%)]				χ²=9.077	0.003
男性	2076(53.7)	2033(53.4)	43(74.1)
女性	1790(46.3)	1775(46.6)	15(25.9)
受教育程度[例(构成比,%)]				χ²=3.860	0.145
小学及以下	2175(56.3)	2137(56.1)	38(65.5)
初中	1262(32.6)	1250(32.8)	12(20.7)
高中及以上	429(11.1)	421(11.1)	8(13.8)
家庭人均年收入[例(构成比,%)]				χ²<0.001	1.000
<6000元	2445(63.2)	2408(63.2)	37(63.8)
≥6000元	1421(36.8)	1400(36.8)	21(36.2)
体质量[例(构成比,%)]					0.031^a
正常	1985(51.3)	1950(51.2)	35(60.4)
过低	163(4.2)	157(4.1)	6(10.3)
超重	1254(32.4)	1242(32.6)	12(20.7)
肥胖	464(12.1)	459(12.1)	5(8.6)
吸烟[例(构成比,%)]					0.013^a
从不	2398(62.0)	2369(62.2)	29(50.0)
正在	1367(35.4)	1343(35.3)	24(41.4)
已戒	101(2.6)	96(2.5)	5(8.6)
饮酒[例(构成比,%)]				χ²=2.827	0.093
否	2870(74.2)	2833(74.4)	37(63.8)
是	996(25.8)	975(25.6)	21(36.2)
结核病患者密切接触史[例(构成比,%)]					0.399^a
无	3451(89.3)	3401(89.4)	50(86.3)
有	240(6.2)	234(6.1)	6(10.3)
不确定	175(4.5)	173(4.5)	2(3.4)
免疫功能失调[例(构成比,%)]					0.272^a
无	3798(98.2)	3742(98.3)	56(96.6)
有	68(1.8)	66(1.7)	2(3.4)
2型糖尿病[例(构成比,%)]					0.015^a
无	3603(93.2)	3554(93.3)	49(84.5)
有	263(6.8)	254(6.7)	9(15.5)
肺炎[例(构成比,%)]					0.250^a
无	3847(99.5)	3790(99.5)	57(98.3)
有	19(0.5)	18(0.5)	1(1.7)
慢性肺部疾病[例(构成比,%)]					0.304^a
无	3705(95.8)	3651(95.9)	54(93.1)
有	161(4.2)	157(4.1)	4(6.9)
心血管疾病[例(构成比,%)]					0.796^a
无	3602(93.2)	3547(93.1)	55(94.8)
有	264(6.8)	261(6.9)	3(5.2)
恶性肿瘤[例(构成比,%)]					1.000^a
无	3843(99.4)	3785(99.4)	58(100.0)
有	23(0.6)	23(0.6)	0(0.0)
省份[例(构成比,%)]				χ²=3.599	0.308
湖南	1171(30.3)	1154(30.3)	17(29.3)
甘肃	842(21.8)	829(21.8)	13(22.4)
江苏	1052(27.2)	1041(27.3)	11(19.0)
河南	801(20.7)	784(20.6)	17(29.3)

特征	潜伏感染者 (例)	肺结核患者 (例)	O₃		NO₂		SO₂		CO
特征	潜伏感染者 (例)	肺结核患者 (例)	HR(95%CI)值	P_交互值	HR(95%CI)值	P_交互值	HR(95%CI)值	P_交互值	HR(95%CI)值	P_交互值
全人群	3866	58	1.151 (0.815~1.624)		1.542 (0.858~2.772)		1.810 (1.153~2.843)		1.196 (1.031~1.388)
年龄组(岁)				0.557		0.137		0.080		0.055
18~44	889	12	1.124 (0.412~3.063)		1.468 (0.318~6.770)		1.057 (0.355~3.151)		1.009 (0.708~1.439)
45~59	1470	16	1.392 (0.723~2.680)		1.617 (0.488~5.354)		1.206 (0.415~3.503)		1.086 (0.786~1.501)
≥60	1507	30	1.078 (0.620~1.872)		1.573 (0.665~3.720)		2.091 (1.166~3.750)		1.275 (1.044~1.557)
性别				0.746		0.859		0.731		0.971
男性	2076	43	1.306 (0.878~1.943)		1.757 (0.836~3.695)		1.674 (0.986~2.843)		1.184 (0.994~1.410)
女性	1790	15	0.799 (0.414~1.539)		1.072 (0.424~2.709)		2.068 (0.886~4.827)		1.185 (0.896~1.566)
受教育程度				0.134		0.693		0.661		0.950
小学及以下	2175	38	0.977 (0.672~1.422)		1.203 (0.656~2.204)		1.844 (1.058~3.212)		1.185 (0.988~1.422)
初中	1262	12	1.513 (0.698~3.282)		NA		2.100 (0.683~6.458)		1.299 (0.927~1.821)
高中及以上	429	8	1.575 (0.429~5.782)		1.552 (0.224~10.750)		1.455 (0.306~6.923)		1.059 (0.634~1.767)
家庭人均年收入(元)				0.491		0.629		0.828		0.904
<6000	2445	37	1.214 (0.813~1.813)		1.528 (0.747~3.127)		1.962 (1.024~3.759)		1.273 (1.028~1.576)
≥6000	1421	21	1.289 (0.564~2.945)		2.821 (0.500~15.918)		2.196 (1.038~4.646)		1.223 (0.970~1.543)
体质量				0.455		0.771		0.706		0.420
正常	1985	35	1.088 (0.758~1.561)		1.464 (0.771~2.778)		1.617 (0.941~2.779)		1.132 (0.957~1.339)
过低	163	6	NA		NA		NA		NA
超重	1254	12	2.014 (0.572~7.095)		NA		1.690 (0.552~5.180)		1.432 (0.929~2.207)
肥胖	464	5	2.468 (0.124~49.273)		0.110 (0.001~9.921)		22.154 (0.467~1051.583)		1.856 (0.811~4.249)
吸烟				0.947		0.693		0.408		0.446
从不	2398	29	1.247 (0.745~2.087)		1.607 (0.721~3.581)		1.722 (0.907~3.268)		1.189 (0.959~1.474)
正在	1367	24	1.091 (0.667~1.784)		1.371 (0.631~2.978)		2.006 (1.011~3.982)		1.261 (1.006~1.581)
已戒	101	5	NA		NA		NA		NA
饮酒				0.581		0.104		0.491		0.739
否	2870	37	1.341 (0.892~2.015)		1.830 (0.920~3.638)		1.681 (0.991~2.851)		1.139 (0.957~1.355)
是	996	21	0.838 (0.506~1.386)		0.956 (0.411~2.225)		2.405 (0.970~5.962)		1.405 (1.032~1.912)

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暴露窗口	O₃		NO₂		SO₂		CO
暴露窗口	HR(95%CI)值	P值	HR(95%CI)值	P值	HR(95%CI)值	P值	HR(95%CI)值	P值
1个月	1.092(0.970~1.229)	0.145	1.008(0.698~1.456)	0.966	1.209(0.700~2.087)	0.496	1.044(0.859~1.268)	0.668
2个月	1.073(0.931~1.236)	0.334	0.955(0.661~1.379)	0.804	1.093(0.648~1.841)	0.739	0.947(0.749~1.195)	0.644
3个月	1.060(0.895~1.256)	0.499	0.975(0.689~1.378)	0.884	1.080(0.678~1.721)	0.745	1.060(0.897~1.253)	0.494
6个月	1.151(0.815~1.624)	0.425	1.542(0.858~2.772)	0.148	1.810(1.153~2.843)	0.010	1.196(1.031~1.388)	0.018
12个月	0.549(0.287~1.051)	0.070	0.536(0.140~2.048)	0.362	1.714(0.921~3.189)	0.089	1.202(1.009~1.433)	0.039