Association between outdoor SO2 and NO2 exposure and latent tuberculosis infection risk among middle school students
Objective To explore the association between outdoor air pollutants sulfur dioxide (SO2) and nitrogen dioxide (NO2) exposure and latent tuberculosis infection (LTBI) risk among middle school students. Methods Basic information and LTBI screening results were collected from students undergoing entrance physical examinations in 68 middle schools across six prefecture-level cities in eastern China from 2018 to 2021. The LTBI test was conducted using the purified protein derivative method. Additionally,data on outdoor air pollutant concentrations and meteorological factors in these six cities from 2015 to 2021 were extracted. A generalized additive model was employed to assess the impact of SO2 and NO2 exposure on the risk of LTBI among middle school students,and sensitivity and subgroup analyses were further performed. Results A total of 198275 students were included in the final analysis,of which 11721 students were diagnosed with LTBI. Compared with the non-LTBI group,the LTBI group had a higher proportion of males and Han ethnicity,as well as older age and higher body mass index (all P<0.001). With every 10 units increase in SO2 concentration,LTBI risk increased by 12.22％(95％CI:4.47-20.54),23.25％ (95％CI:16.13-30.81),and 22.77％ (95％CI:16.78-29.07) at lag times of one year,two years,and three years,respectively. Similarly,for every 10 units increase in NO2 concentration,LTBI risk increased by 22.20％ (95％CI:17.23-27.38),27.22％ (95％CI:21.41-33.31),and 32.05％ (95％CI:25.76-38.65),respectively,at the corresponding lag times. Furthermore,the positive association between SO2 and NO2 concentrations and the risk of LTBI was robust in the sensitivity analyses and remained significant in both male and female students. Conclusions Outdoor air pollutants SO2 and NO2 exposure are positively associated with the risk of LTBI among middle school students. Since many developing countries face the dual challenges of high LTBI rates and severe outdoor air pollution,reducing outdoor air pollutant concentrations may help mitigate the tuberculosis burden in these countries.
Tuberculosislatent infectionair pollutiontime-series analysismiddle school students
万方数据
