Ambient air pollutants, diabetes and risk of newly diagnosed drug-resistant tuberculosis.

Drug-resistant tuberculosis (DR-TB), diabetes and exposure to air pollution are thought to be important threat to human health, but no studies have explored the effects of ambient air pollutants on DR-TB when adjusting diabetes status so far. We performed a study among 3759 newly diagnosed TB cases with drug-susceptibility testing results, diabetes status, and individual air pollution data in Shandong from 2015 to 2019. Generalized linear mixed models (GLMM) including three models (Model 1: without covariates, Model 2: adjusted by diabetes status only, Model 3: with all covariates) were applied. Of 3759 TB patients enrolled, 716 (19.05%) were DR-TB, and 333 (8.86%) had diabetes. High exposure to O 3 was associated with an increased risk of RFP-resistance (Model 2 or 3: odds ratio (OR) = 1.008, 95% confidence intervals (CI): 1.002–1.014), ethambutol-resistance (Model 3: OR = 1.015, 95%CI: 1.004–1.027) and any rifampicin+streptomycin resistance (Model 1,2,3: OR = 1.01, 95%CI: 1.002–1.018) at 90 days. In contrast, NO 2 was associated with a reduced risk of DR-TB (Model 3: OR = 0.99, 95%CI: 0.981–0.999) and multidrug-resistant TB (MDR-TB) (Model 3: OR = 0.977, 95%CI: 0.96–0.994) at 360 days. Additionally, SO 2 (Model 1, 2, 3: OR = 0.987, 95%CI: 0.977–0.998) showed a protective effect on MDR-TB at 90 days. PM 2.5 (90 days, Model 2: OR = 0.991, 95%CI: 0.983–0.999), PM 10 (360 days, Model 2: OR = 0.992, 95%CI: 0.985–0.999) had protective effects on any RFP+SM resistance. O 3 contributed to an elevated risk of TB resistance but PM 2.5 , PM 10 , SO 2 , NO 2 showed an inverse effect. Air pollutants may affect the development of drug resistance among TB cases by adjusting the status of diabetes. [Display omitted] • O 3 was a risk factor for rifampicin, ethambutol, and any rifampicin+streptomycin resistance. • Protective effects were observed among PM 10 /PM 2.5 /NO 2 /SO 2 on some tuberculosis resistance. • Air pollutants may affect the development of TB resistance by adjusting the status of diabetes. • Controlling particular air pollutants and diabetes may help decrease tuberculosis resistance. [ABSTRACT FROM AUTHOR]