室外空氣汙染和結核病之相關性研究

賴亭君

doi:10.6342/NTU.2013.10017

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室外空氣汙染和結核病之相關性研究

Association between Ambient Air Pollution and Tuberculosis: Prospective Cohort Study

賴亭君 , Masters　　Advisor：林先和　　Co-advisor ：詹長權

英文 DOI： 10.6342/NTU.2013.10017

室外空氣汙染；結核病；前瞻性世代研究；最近測站法；土地利用回歸模式； ambient air pollution ； tuberculosis ； prospective cohort study ； nearest station method ； land use regression model

Abstract │ Reference (41) │ Altmetrics

Abstract 〈TOP〉

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Background:
Several respiratory risk factors have been report to be possibly associated with tuberculosis (TB). To our knowledge, there was no study on the association between ambient air pollution and risk of TB. Since the problem of air pollution is serious in developing countries where the burden of TB is high, there is a need to understand the association between ambient air pollution and TB.

Design/Methods: 
We included 104,196 participants (>=30 years of age) who were enrolled in community integrated health screening service in New Taipei City from 2005~2008. All participants were followed up to the end of 2011. Using the home address of participants, we estimated the individual-level of ambient air pollution by three methods. In the nearest station method, the level of pollutant for each participant was assigned based on the pollution level in the monitoring station that was closest to the individual’s address. Secondly, we applied the land use regression model that was developed and validated in the previous European Study of Cohorts for Air Pollution Effects project to estimate the level of pollutant at the individual level. Lastly, we used heavily trafficked roadway proximity to be a proxy measure of air pollution. The occurrence of TB disease during follow-up was ascertained by linking the health screening database to national TB registry of Taiwan Centers for Disease Control. Cox proportional hazards model was used to estimate the association between ambient air pollution and active TB, adjusting for potential confounders.

Results: 
After median follow-up of 5.4 years, 312 cases of incident TB occurred among 104,196 participants (incidence rate: 58/100, 000). After adjusting for potential confounders, the length of road in buffer 300m (adjusted HR, 1.12[1.02, 1.23]) and the length of major road in buffer 500m (adjusted HR, 1.10[1.02, 1.19]), a proxy measure of air pollution were associated with increased risk of TB incidence. In the nearest station method, NO2 (adjusted HR, 1.29[0.98, 1.69]) and NOx (adjusted HR, 1.21[1.02, 1.43]) were shown to increase TB risk. The results for pulmonary TB were similar to that from the main analysis. However we found HRs increased for culture-confirmed TB in all pollutants and positive air pollution predictors. In the subgroup analysis, we restricted the study population to the urban districts and found these regions were homogeneous in baseline characteristics. In the subgroup analysis, the association between air pollution measured by land use regression and risk of TB became stronger. On the other hand, the association between air pollution measured by the nearest station method and TB did not become stronger in subgroup analysis.

Conclusions: 
To our knowledge, our study is the first epidemiological study on ambient air pollution and TB. The length of road and length of major road in the close proximity, and NO2 and NOx were found to be associated with increased risk of TB. Further studies of larger sample size and accurate land use regression model will help clarify the impact of air pollution on TB.

Reference ( 41 ) 〈TOP〉

1. World Health Organization, GLOBAL TUBERCULOSIS REPORT. WHO, 2012.
連結：
2. Lienhardt, C., From exposure to disease: The role of environmental factors in susceptibility to and development of tuberculosis. Epidemiologic Reviews, 2001. 23(2): p. 288-301.
連結：
3. Lonnroth, K., et al., Drivers of tuberculosis epidemics: the role of risk factors and social determinants. Soc Sci Med, 2009. 68(12): p. 2240-6.
連結：
4. Lin, H.H., M. Ezzati, and M. Murray, Tobacco smoke, indoor air pollution and tuberculosis: A systematic review and meta-analysis. Plos Medicine, 2007. 4(1): p. 173-189.
連結：
5. Leung, C.C., et al., Smoking and tuberculosis among the elderly in Hong Kong. American Journal of Respiratory and Critical Care Medicine, 2004. 170(9): p. 1027-1033.
連結：

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