Association Between Exposure to Ozone (O3) and the Short-Term Effect on Tuberculosis Outpatient Visits: A Time-Series Study in 16 Cities of Anhui Province, China

Abstract

Shuangshuang Chen,1– 3,* Xinqiang Wang,4,* Danhui Li,5,* Jiawen Zhao,4 Jingjing Zhang,3 Yongzhong Zhang,6 Xiujun Zhang,4 Xiaohong Kan2– 4 1Department of Tuberculosis Prevent and Control, Center for Disease Control and Prevention of Hefei, Hefei, Anhui, 230051, People’s Republic of China; 2Department of Scientific Research and Education, Anhui Chest Hospital, Hefei, Anhui, 230022, People’s Republic of China; 3Department of Scientific Research and Education, Anhui Provincial Tuberculosis Institute, Hefei, Anhui, 230022, People’s Republic of China; 4Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, People’s Republic of China; 5Department of Hospital Infection and Management, Anhui Chest Hospital, Hefei, Anhui, 230022, People’s Republic of China; 6Department of Tuberculosis Prevent and Control, Anhui Provincial Tuberculosis Institute, Hefei, Anhui, 230022, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xiaohong Kan, Department of Scientific Research and Education, Anhui Chest Hospital (Anhui Provincial Tuberculosis Institute), Hefei, Anhui, 230022, People’s Republic of China, Email [email protected] Xiujun Zhang, Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, 230032, People’s Republic of China, Email [email protected]: Evidence has shown that air pollutant exposure plays a vital role in the progression of tuberculosis (TB). The aim of this research was to assess the short-term effects of ozone (O3) exposure and TB outpatient visits in 16 prefecture-level cities of Anhui, China, 2015– 2020.Methods: Distributed lag nonlinear model (DLNM), Poisson generalized linear regression model and random effects model were applied in this study. The effects of different age and gender on TB were investigated by stratified analysis, and then we performed sensitivity analyses to verify the stability of the results.Results: A total of 186,623 active TB cases were registered from January 1, 2015 to December 31,2020 in Anhui. The average concentration of ozone is 92.77 ± 42.95 μg/m3. The maximum lag-specific and cumulative relative risk (RR) of TB outpatient visits was 1.0240 (95% CI: 1.0170– 1.0310, lag 28 days) for each 10 μg/m³ increase in O3 in the single-pollutant model. Estimation for 16 prefecture-level cities indicated that the strong association between O3 and the risk of TB outpatient visits was in tongling (RR = 1.0555, 95% CI: 1.0089– 1.1042), Suzhou (RR = 1.0475, 95% CI: 1.0268– 1.0687), wuhu (RR = 1.0358, 95% CI: 1.0023– 1.0704). Stratified analysis showed that the health effects of ozone exposure remained significant in male and older adults, and there was no significant association between exposure to ozone in children and adolescents and the risk of tuberculosis.Discussion: We found that ozone exposure increases the risk of TB infection in outpatient patients, with males and the elderly being more susceptible, and it is necessary for government departments to develop targeted publicity and prevention measures in response to the local air quality conditions.Keywords: air pollution, ozone, tuberculosis, distributed lag nonlinear model, Poisson generalized linear regression model

Keywords

• air pollution
• ozone
• tuberculosis
• distributed lag nonlinear model
• poisson generalized linear regression model