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Evidence on the spatial-temporal distribution of tuberculosis (TB) mortality across China and its relationship with long-term particulate matter (PM _2.5 ) exposure is limited. We aimed to address significant gaps in our understanding of the spatial-temporal clustering patterns of TB mortality in China and provide evidence for its causal links with long-term PM _2.5 exposure. Annual pulmonary TB mortality, PM _2.5 concentrations, and socioeconomic factors for provinces in mainland China between 2004 and 2017 were obtained. Turning points in the temporal trend and spatial clustering patterns of pulmonary TB mortality were identified. A difference-in-differences causal inference approach was applied to estimate the long-term effect of PM _2.5 exposure on the mortality. The average annual percent change of pulmonary TB mortality in China was −2.5% (95% CI : −5.6%, 0.7%), with an 11.1% annual increase in the Northwest since 2012 ( P = 0.029). The hot and cold spots, determined by the local Moran’s I index, were all located in northern China, where Xinjiang in the Northwest had the highest mortality across the study period. We found a significant association between long-term PM _2.5 exposure and pulmonary TB mortality, with percent increase risk of mortality ( IR %) being 0.74% (95 CI %, 0.04%, 1.45%) for 1 µ g/m ^3 increase in PM _2.5 concentration. This association varied across multiple socioeconomic groups, with the highest IR % in provinces with lower level of latitude ( IR % = 0.83%, 95% CI : 0.01%, 1.65%), lower quartile of gross domestic product ( IR % = 1.01%, 95% CI: 0.23%, 1.80%) or higher proportion (⩾14%) of people >65 years of age ( IR % = 1.24%, 95% CI: 0.44%, 2.04%). Comprehensive sensitivity analyses showed a robust adverse effect of long-term PM _2.5 exposure on pulmonary TB mortality. Attention needs to be paid to the rising trend of pulmonary TB mortality in Northwest China. Our study provides the stable evidence to date of the causal association between long-term PM _2.5 exposure and the risk of death from pulmonary TB, especially in low-altitude, underdeveloped, and aged provinces.

Meteorological exposures are well-documented factors underlying the dengue pandemics, and air pollution was reported to have the potential to change the behaviors and health conditions of mosquitos. However, it remains unclear whether air pollution could modify the association of meteorological exposures and the incidence of dengue fever. We matched the dengue surveillance data with the meteorological and air pollution data collected from monitoring sites from 2015 through 2019 in Guangzhou area. We developed generalized additive models with Poisson distribution to regress the daily counts of dengue against four meteorological exposures, while controlling for pollution and normalized difference vegetation index to evaluate the risk ratio (RR) of dengue for each unit increase in different exposures. The interaction terms of meteorological exposures and air pollution were then included to assess the modification effect of different pollution on the associations. Daily dengue cases were nonlinearly associated with one-week cumulative temperature and precipitation, while not associated with humidity and wind speed. RRs were 1.07 (1.04, 1.11) and 0.95 (0.88, 1.03) for temperature below and above 27.1 °C, 0.97 (0.96, 0.98) and 1.05 (1.01, 1.08) for precipitation below and above 20.3 mm, respectively. For the modification effect, the RRs of low-temperature, wind speed on higher SO _2 days and low-precipitation on both higher PM _2.5 and SO _2 days were greater compared to the low-pollution days with P _interaction being 0.037, 0.030, 0.022 and 0.018. But the RRs of both high-temperature on higher SO _2 days and high-precipitation on higher PM _2.5 d were smaller with P _interaction being 0.001 and 0.043. Air pollution could alter the meteorology-dengue associations. The impact of low-temperature, low-precipitation and wind speed on dengue occurrence tended to increase on days with high SO _2 levels while the impact of high-temperature decreased. The impact of low-precipitation increased on high-PM _2.5 d while the impact of high-precipitation decreased.