Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Jun 23, 2023
Date Accepted: Jun 5, 2024
Association of Fine Particulate Matter and Residential Greenness with Risk of Pulmonary Tuberculosis Retreatment: A Population-based Retrospective Study
ABSTRACT
Background:
The evidence on the association of fine particulate matter (PM2.5) with tuberculosis (TB) recurrence is limited. There are no data on whether greenness exposure protects air pollution-related PTB recurrence in patients with prior TB.
Objective:
In a population-based retrospective study, we aimed to investigate the influence of PM2.5 and residential greenness on the risk of PTB recurrence.
Methods:
A total of 26 482 incident PTB patients, registered in a mandatory online reporting system between 2012 and 2019 in Zhengzhou, China, were included in the analysis. The exposure to PM2.5 was assessed based on the China High Air Pollutants (CHAP) dataset and the level of greenness was estimated using the Normalized Difference Vegetation Index (NDVI) values. The associations of PTB recurrence with exposure to PM2.5 and greenness were evaluated respectively considering the local socioeconomic level indicated by the nighttime light (NTL) index.
Results:
Among 26 482 patients (mean age 48.9 years [SD 19.5]) with a median follow-up time of 1425 days per patient, 1542 PTB recurrences were observed between 2012 and 2019. Exposure to PM2.5 was observed to be significantly associated with the increased risk of PTB recurrence in fully adjusted models with a hazard ratio (HR) of 2.0 (95% CI, 1.3-2.8) per 10 μg/m3 increase in PM2.5. Patients living in the regions with relatively high quartiles of NDVI values had a 40% lower risk of PTB recurrence than those living in the regions with the lowest quartile for the 500m buffers (HR, 0.6; 95% CI,0.4-0.8). Such a protective effect of residential greenness was more pronounced among patients living in lower NTL areas. The strength of the association between PM2.5 exposure and the risk of PTB recurrence was attenuated by greenness. No significant association was observed between NDVI and the incidence of drug resistance.
Conclusions:
Long-term exposure to PM2.5 might be a risk factor for PTB recurrence, while an increased level of residential greenness was found to be associated with reduced risks of PTB recurrence. Our results suggest strengthening the control of ambient air pollution and improving residential greenness have important significance for PTB control and one health practice.
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