PMID- 36435281 OWN - NLM STAT- MEDLINE DCOM- 20230105 LR - 20230111 IS - 1873-6424 (Electronic) IS - 0269-7491 (Linking) VI - 317 DP - 2023 Jan 15 TI - Effects of long-term ambient air pollution exposure on township-level pulmonary tuberculosis notification rates during 2005-2017 in Ningxia, China. PG - 120718 LID - S0269-7491(22)01932-7 [pii] LID - 10.1016/j.envpol.2022.120718 [doi] AB - Studies examining long-term effects of ambient air pollution exposure, measured as annual averages, on pulmonary tuberculosis (TB) incidence are scarce, particularly in endemic, rural settings. We performed a small-area study in Ningxia Hui Autonomous Region (NHAR), a high TB-burden area in rural China, using township-level (n = 358 non-overlapping townships) annual TB notification data (2005-2017). We aimed to determine if annual average concentrations of ambient air pollution (particulate matter <2.5 mum [PM(2.5)], nitrogen dioxide [NO(2)] ozone [O(3)]) were associated with TB notification rates (as a proxy for incidence). Air pollution effects on TB notification rates at township-level were estimated as incidence rate ratios (IRR), fitted using a generalised estimating equation (GEE) adjusted for covariates (age, sex, occupation, education, ethnicity, remoteness [urban or rural], household crowding and solid fuel use). A total of 38,942 TB notifications were reported in NHAR between 2005 and 2017. The mean annual TB notification rate was 67 (standard deviation [SD]; 7) per 100,000 people. Median concentrations of PM(2.5), NO(2), and O(3) were 42 mug/m(3) (interquartile range [IQR]; 38-48 mug/m(3)), 15 ppb (IQR; 12-16 ppb), and 56 ppb (IQR; 56-57 ppb), respectively. In single pollutant models, adjusted for covariates, an interquartile range (IQR) increase (10 mug/m(3)) in PM(2.5) was significantly associated with higher TB notification rates (IRR: 1∙35; 95% CI: 1.25-1.48). Comparable effects on notifications of TB were observed for increases in NO(2) exposure (IRR: 1.20 per IQR (4 ppb) increase; 95% CI: 1.08-1.31). Ground-level ozone was not associated with TB notification rate in any models. The observed effects were consistent over time, in multi-pollutant models, and appeared robust to additional adjustment for indicators of household crowding, solid fuel use and remoteness. More rigorous study designs are needed to understand if improving air quality has population-level benefits on TB disease incidence in endemic settings. CI - Copyright (c) 2022 Elsevier Ltd. All rights reserved. FAU - Popovic, Igor AU - Popovic I AD - Faculty of Medicine, School of Public Health, University of Queensland, Herston, 4006, Australia; UQ Spatial Epidemiology Laboratory, School of Veterinary Science, University of Queensland, Gatton, 4343, Australia. Electronic address: i.popovic@uq.edu.au. FAU - Soares Magalhaes, Ricardo J AU - Soares Magalhaes RJ AD - UQ Spatial Epidemiology Laboratory, School of Veterinary Science, University of Queensland, Gatton, 4343, Australia; Children's Health and Environment Program, UQ Children's Health Research Center, The University of Queensland, South Brisbane, 4101, Australia. FAU - Yang, Yurong AU - Yang Y AD - Department of Pathogenic Biology & Medical Immunology, School of Basic Medical Science, Ningxia Medical University, Yinchuan, 750004, China. FAU - Yang, Shukun AU - Yang S AD - Department of Radiology, The Second Affiliated Hospital of Ningxia Medical University, The First People's Hospital in Yinchuan, Yinchuan, 750004, China. FAU - Yang, Boyi AU - Yang B AD - Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510085, China. FAU - Dong, Guanghui AU - Dong G AD - Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, 510085, China. FAU - Wei, Xiaolin AU - Wei X AD - Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5S 1A1, Canada. FAU - Fox, Greg J AU - Fox GJ AD - Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, NSW, 2006, Australia. FAU - Hammer, Melanie S AU - Hammer MS AD - Department of Energy, Environmental, and Chemical Engineering, Washington University, St Louis, 63130, United States. FAU - Martin, Randall V AU - Martin RV AD - Department of Energy, Environmental, and Chemical Engineering, Washington University, St Louis, 63130, United States; Department of Physics and Atmospheric Science, Dalhousie University, Halifax, B3H 3J5, Canada. FAU - van Donkelaar, Aaron AU - van Donkelaar A AD - Department of Energy, Environmental, and Chemical Engineering, Washington University, St Louis, 63130, United States; Department of Physics and Atmospheric Science, Dalhousie University, Halifax, B3H 3J5, Canada. FAU - Ge, Erjia AU - Ge E AD - Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5S 1A1, Canada. FAU - Marks, Guy B AU - Marks GB AD - South Western Sydney Clinical School, University of New South Wales, Liverpool, 2170, Australia; Woolcock Institute of Medical Research, Glebe, 2037, Australia. FAU - Knibbs, Luke D AU - Knibbs LD AD - Public Health Unit, Sydney Local Health District, Camperdown, 2050, Australia; Faculty of Medicine and Health, School of Public Health, The University of Sydney, Camperdown, 2006, Australia. LA - eng PT - Journal Article DEP - 20221123 PL - England TA - Environ Pollut JT - Environmental pollution (Barking, Essex : 1987) JID - 8804476 RN - 0 (Air Pollutants) RN - S7G510RUBH (Nitrogen Dioxide) RN - 0 (Particulate Matter) RN - 66H7ZZK23N (Ozone) RN - 0 (Environmental Pollutants) SB - IM MH - Humans MH - *Air Pollutants/analysis MH - Nitrogen Dioxide/analysis MH - Crowding MH - Environmental Exposure/analysis MH - Family Characteristics MH - *Air Pollution/analysis MH - Particulate Matter/analysis MH - *Ozone/analysis MH - *Environmental Pollutants MH - China/epidemiology MH - *Tuberculosis, Pulmonary/epidemiology OTO - NOTNLM OT - Ambient air pollution OT - Ground level ozone OT - Nitrogen dioxide OT - Particulate matter OT - TB OT - Tuberculosis COIS- Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. EDAT- 2022/11/27 06:00 MHDA- 2023/01/06 06:00 CRDT- 2022/11/26 19:24 PHST- 2022/06/09 00:00 [received] PHST- 2022/11/17 00:00 [revised] PHST- 2022/11/20 00:00 [accepted] PHST- 2022/11/27 06:00 [pubmed] PHST- 2023/01/06 06:00 [medline] PHST- 2022/11/26 19:24 [entrez] AID - S0269-7491(22)01932-7 [pii] AID - 10.1016/j.envpol.2022.120718 [doi] PST - ppublish SO - Environ Pollut. 2023 Jan 15;317:120718. doi: 10.1016/j.envpol.2022.120718. Epub 2022 Nov 23.