Ambient air pollution exposures and risk of drug-resistant tuberculosis.
BACKGROUND
Few epidemiological studies have explored the effects of air pollution on the risk of drug-resistant tuberculosis (DR-TB).


OBJECTIVE
To investigate the short and long term residential concentrations of ambient air pollutants (particulate matter <10 μm in diameter (PM10) and particulate matter≤2.5 μm in diameter (PM2.5), nitrogen dioxide (NO2), sulfur dioxide (SO2), ozone (O3), and carbon monoxide (CO)) in relation to the risk of DR-TB in a typical air pollution city, Jinan city, China.


METHODS
A total of 752 new culture-confirmed TB cases reported in TB prevention and control institutions of Jinan from January 1, 2014 to December 31, 2015 were included. Average individual-level concentrations of air pollution for 5 different exposure windows, vary from 90 days to 720 days to diagnosis were estimated using measurements from monitor closest to the patient home addresses. Logistic regression model adjusted for potential confounders was employed to evaluate correlation between air pollution and DR-TB risk at different five exposure windows individually.


RESULTS
There were substantially increased mono-drug resistance and poly-drug resistance risks for ambient PM2.5, PM10, O3, and CO exposures. High exposure to PM2.5, PM10, and CO was also significantly associated with increased incidence of multi-drug resistance (MDR) both in the single- and multi-pollutants regression models. The dominant positive associations for PM2.5was observed at 540 days exposure, for O3 was observed at 180 days exposure, and for PM10 and CO was observed from 90 days to 540 days exposures.


CONCLUSIONS
Our finding suggest that exposure to ambient air pollution (PM2.5, PM10, O3, and CO) are associated with increased risk of DR-TB. We provided epidemiological evidence of association between pollution exposure and mono-, poly- and multi-drug resistance.
['Yao|Liu|L|', 'LiangLiang|Cui|C|', 'JinYue|Liu|L|', 'WanMei|Song|S|', 'Lili|Su|S|', 'YiFan|Li|L|', 'HuaiChen|Li|L|']
D000328:Adult D000393:Air Pollutants D002248:Carbon Monoxide D002681:China D004781:Environmental Exposure D005260:Female D006801:Humans D015994:Incidence D008297:Male D008875:Middle Aged D009585:Nitrogen Dioxide D010126:Ozone D052638:Particulate Matter D012189:Retrospective Studies D018570:Risk Assessment D013458:Sulfur Dioxide D018088:Tuberculosis, Multidrug-Resistant D055815:Young Adult
Air pollution Drug-resistant China Tuberculosis (TB)