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Background: Previous studies addressing the impact of environmental factors on TB prognosis are scarce, with only some studies examining the effect of particulate pollutants on TB mortality. Moreover, few studies have evaluated the effects of multiple gaseous pollutants and greenness exposures on newly treated TB patients on a large population scale. Methods: Through the Centers for Disease Control and Prevention, data were collected from January 1, 2015 to December 31, 2020 for newly treated TB patients in Anhui Province, China. Data on gaseous pollutants sulfur dioxide, nitrogen dioxide, carbon monoxide, and ozone were collected through the National Earth System Science Data Center of China. Normalized vegetation index data were obtained through NASA. The Cox proportional risk model was also applied to calculate the hazard ratios of SO2, NO2, CO, O3, and NDVI with 95% confidence intervals for mortality among newly treated TB patients. Results: Multifactorial Cox regression analysis showed that for every 0.10 μg/m3 increase in SO2, the risk of death among newly treated TB patients increased by 13.2% (HR = 1.132, 95% CI: 1.045–1.1.225), for every 10 μg/m3 increase in NO2, the risk of death among newly treated TB patients increased by 11.4%, and for each 0.1 mg/m3 increase in CO, the risk of death among newly treated TB patients increased by 5.8%. For each 0.1 increase in NDVI 250m-buffer and 500m-buffer, the risk of death among newly treated TB patients decreased by 8.5% and 6.4%, respectively. The effect of gaseous pollutants on mortality decreased progressively with elevated greenness exposure when greenness exposure was grouped from low to high. Conclusion: Gaseous pollutants are a risk factor during the treatment of newly treated TB patients and greenness exposure is a protective factor. Higher greenness exposure reduces the risk of death due to exposure to gaseous pollutants. [ABSTRACT FROM AUTHOR]

Some previous studies had linked air pollutants and greenness to the risk of death from tuberculosis (TB). Only a few studies had examined the effect of particulate matter (PM2.5) on the mortality of TB, and few studies had assessed the impact and interaction of multiple air pollutants and greenness on the mortality of newly treated TB patients. The study included 29,519 newly treated TB patients from three cities in Anhui province. We collected meteorological data and five pollutants data from The National Meteorological Science Center and air quality monitoring stations. Greenness data were generated by remote sensing inversion of medium-resolution satellite images. We geocoded each patient based on the residential address to calculate the average exposure to air pollutants and the average greenness exposure for each patient during treatment. The Cox proportional risk regression model was used to evaluate the effects of air pollutants and greenness on mortality in newly treated tuberculosis patients. Our results found that the higher the concentration of air pollutants in the living environment of newly treated TB patients, the greater the risk of death: HR 1.135 (95% CI: 1.123–1.147) and HR 1.333 (95% CI: 1.296–1.370) per 10 μg/m3 of PM2.5 and SO2, respectively. Greenness reduced the mortality among newly treated TB patients: HR for NDVI exposure 0.936 (95% CI: 0.925–0.947), HR for NDVI_250m exposure 0.927 (95% CI: 0.916–0.938), and HR for NDVI_500m exposure 0.919 (95% CI: 0.908–0.931). Stratifying the cohort by median greenness exposure, HRs for air pollutants were lower in the high greenness exposure group. Mortality in newly treated TB patients is influenced by air pollutants and greenness. Higher green exposure can mitigate the effects of air pollution. Improving air quality may help reduce mortality among newly treated TB patients. [ABSTRACT FROM AUTHOR]

A growing number of biological studies suggest that exogenous sulfur dioxide (SO2) at a certain concentration may promote human resistance to Mycobacterium tuberculosis. However, the results of most relevant studies are inconsistent, and few studies have explored the relationship between SO2 exposure and tuberculosis risk at provincial level. In addition, occupational exposure has long been considered to have a certain impact on the human body, so for the first time, we discussed the differences between different occupations in the study on the relationship between air pollutant exposure and tuberculosis risk, and evaluated the impact of occupational exposure. This study aimed to explore the association between short-term SO2 exposure and the risk of outpatient visits to tuberculosis in Anhui province and 16 prefecture-level cities from 2015 to 2020. We used several models for multi-stage analysis, including distributed lag nonlinear model (DLNM), Poisson generalized linear regression model, and random-effects model. The association was assessed using the 28-day cumulative lag effect RR and 95%CI for each 10-unit increase in SO2 concentration. We divided all patients into the following six occupations: Worker, Farmer, Retired people, Children and Students, Cadre and Office clerk, and Service staff (catering, business, etc.). Sex, age, and season were analyzed by subgroup. Finally, the robustness of the multi-pollutant model was tested. At provincial level, the overall effect value of SO2 was RR=0.8191 (95%CI: 07702~0.8712); after grouping all patients by occupation, the association found only among Farmers (RR = 0.7150, 95%CI: 0.6699–0.7632, lag 0–28 days) and Workers (RR = 0.8566, 95%CI: 0.7930–0.9930, lag 0–4 days) was still statistically significant. Estimates for individual cities and using random-effects models to estimate average associations showed that SO2 exposure was associated with a reduced risk of outpatient TB visits in 14 municipalities, which remained significant when aggregated (RR = 0.9030, 95%CI: 0.8730–0.9340). Analysis of patients grouped by occupation in each municipality showed that statistical significance was again observed only in the Farmer (RR = 0.8880, 95%CI: 0.8610–0.9160) and Worker (RR = 0.8250, 95%CI: 0.7290–0.9340) groups. Stratified analysis of age, sex, and season showed that the effect of SO2 exposure was greater for middle-aged people (18–64 years old) and males, and less for seasonal changes. In summary, we found that exposure to SO2 reduces the risk of outpatient visits to tuberculosis, with farmers and workers more susceptible to SO2. Gender and age had a greater impact on the risk of TB outpatient visits than seasonal variations. [ABSTRACT FROM AUTHOR]

Tuberculosis (TB) causes about 10 million new cases and 1.5 million deaths every year, as the World Health Organization's Global Tuberculosis Report shows. We aimed to investigate the association between short-term exposure to particulate pollutants and the risk of tuberculosis outpatient visits in 16 cities of Anhui Province, China, during the period 2015–2020, and to provide more evidence for the relationship between tuberculosis and air pollution. In this study, we analyzed the data using a variety of models, including Poisson's generalized linear regression model, distributed lag non-linear model (DLNM) and random effects model. We assessed the relationship between particulate matter exposure and tuberculosis using a 28-day cumulative lag effect for every 10 unit increases in pollutant concentration and 95% CI. We performed stratified analyses for gender and age. Age stratification included <18 years old group, 19–64 years old group and >64 years old group and gender stratification included male group and female group, and then we performed a sensitivity analysis to test the stability of the results. The overall effect values of PM2.5 and PM10 were RR = 1.031 (95%CI: 1.019–1.043) and RR = 1.023 (95%CI: 1.016–1.030), respectively. Estimation for individual cities showed that the strongest association between PM2.5 and the risk of TB outpatient visits was observed in Tongling, with an RR of 1.136 (95%CI: 1.0261–1.2583), also the PM10 in Suzhou, with an RR of 1.0629 (95%CI: 1.0421–1.0842). Stratified analysis showed that particulate matter exposure had a more significant impact on males and the elderly, and that there was little association between particulate matter exposure and TB risk in children and adolescents. Exposure to PM2.5 and PM10 increases the risk of TB outpatient visits. Males and the elderly are vulnerable groups, and different prevention and control strategies should be developed for different groups to reduce the burden of TB. • China's first province-wide study on the TB outpatient visits and particulate pollutants. • Exposure to particulate pollutants increases the risk of tuberculosis outpatient visits. • Exposure to particulate pollutants has a greater impact on male and the elderly. [ABSTRACT FROM AUTHOR]