臺灣地區空氣污染相關結核病之族群傳輸動態及其發生率貢獻評估

Population transmission dynamic modeling of air pollution-associated tuberculosis endemic in regions of Taiwan and their incidence rate contribution assessment

林幸潔(Hsing-Chieh Lin)

指導教授 ： 廖中明

國立臺灣大學/生物資源暨農學院/生物環境系統工程學研究所/碩士(2018年)

https://doi.org/10.6342/NTU201801499

摘要

結核病(Tuberculosis)是臺灣發生率及死亡率最高之法定傳染病，為嚴重之公共衛生議題。近年多數流行病學研究顯示空氣污染之暴露與結核病具正相關，潛在影響結核病之疾病負擔與傳輸。本論文目的為評估空氣污染暴露對結核病發生率貢獻之風險及其傳輸動態之影響。本研究依前人之世代研究資料設定嚴重與中等族群可歸因比率之反應情境以建構空氣污染物濃度與其之劑量反應關係，進而發展一機率風險架構以推估結核病發生率可歸因於暴露空氣污染之比率。此外，建構整合性空氣污染相關結核病族群傳輸動態模式，以研析空氣污染暴露之結核病傳輸動態。建構空氣污染濃度—結核病基本再生數(R0)之劑量反應關係，以擬定空氣污染物濃度之建議值以控制結核病傳播。結果指出，在嚴重情境下之50%超越風險，結核病發生率主要可歸因於一氧化碳(CO)與懸浮微粒(PM10)之暴露；而中等情境下，則以氮氧化物(NOX)與二氧化氮(NO2)為主。空氣污染暴露對結核病低發生率地區之臺北市其結核病發生率貢獻最高。整合性傳輸動態模式可有效預測近十年每月結核病發生率趨勢之能力。結果顯示臺北市、花蓮縣、臺東縣及屏東縣整體之基本再生數推估值皆大於1，表示若此四縣市空氣污染環境暴露會造成結核病持續流行。本研究推論空氣污染具潛在影響結核病之再活化機制。由控制結核病傳輸觀點所推估之空氣污染物濃度建議值：臺北市及屏東縣可分別控制二氧化硫(SO2)年平均濃度低於1.69與1.61 ppb。本論文以風險觀點評估空氣污染對結核病發生率之貢獻，提供整合性傳輸動態模式深入研析空氣污染影響結核病之傳輸機制，並指出主要影響結核病負擔與傳輸之空氣污染物及濃度建議值則有助於發展結核病防治措施。

關鍵字

結核病 ； 空氣污染 ； 風險評估 ； 族群可歸因比率 ； 族群動態 ； 傳輸

並列摘要

Tuberculosis (TB), known as a serious public health issue, is a notifiable communicable disease with the highest incidence and mortality rate in Taiwan. Recent epidemiological studies demonstrated that exposure to air pollution was positively associated with TB development, leading to pose potentially impacts on TB disease burden and transmission. The objectives of this thesis were to assess the contribution risk of air pollution exposure to TB incidence rate and to evaluate the air pollution-associated TB transmission dynamics. This study developed a probabilistic risk framework to estimate the burden of TB incidence rates attributable to air pollution exposure by incorporating the dose-response relationship between air pollution and population attributable fraction (PAF) under severe and moderate scenarios based on the previous cohort study data. An integrated air pollution-associated TB population transmission dynamic model was constructed to elucidate how air pollution exposure influences the TB transmission dynamics. The dose-response relationship between air pollution concentrations and basic reproduction number (R0) was constructed to provide site-specific air pollution concentration recommendations for controlling TB transmission. Results indicated that, under severe PAF scenario at 50% risk probability, TB incidence was mainly attributable to carbon monoxide (CO) and particulate matter with aerodynamic diameter ≤ 10 μm (PM10) exposure among air pollutants; whereas under moderate scenario, the major air pollutants that contributed to TB incidence were nitrogen oxides (NOX) and nitrogen dioxide (NO2). Taipei City had the highest contribution of air pollution exposure to TB incidence. Model validation results indicated that the integrated transmission dynamic model well-described the trends of monthly TB incidence rates in recent 10 years. The estimated total TB R0s in Taipei City, Hualien, Taitung, and Pingtung Counties were greater than 1, implicating that the TB epidemic is highly likely to spread due partly to air pollution exposure. The results also implicated that air pollution exposure had potential impacts on TB reactivation mechanism. Furthermore, for controlling TB transmission, the proposed recommendations of annual average sulfur dioxide (SO2) concentrations should be lower than 1.69 and 1.61 in Taipei City and Pingtung County, respectively. This thesis assessed the contribution of air pollution to TB incidence based on a probabilistic point of view and provided an integrated air pollution-associated transmission dynamic model to understand the impact of air pollution on TB transmission mechanisms. The proposed air pollution recommendations are help for developing the TB control strategies.

並列關鍵字

Tuberculosis ； Air pollution ； Risk assessment ； Population attributable fraction ； Population dynamics ； Transmission

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