Long-term exposure to ambient fine particulate matter (PM2.5) and attributable pulmonary tuberculosis notifications in Ningxia Hui Autonomous Region, China: a health impact assessment

Igor Popovic; Ricardo Soares Magalhaes; Shukun Yang; Yurong Yang; Bo-Yi Yang; Guang-Hui Dong; Xiaolin Wei; Joseph Van Buskirk; Gregory Fox; Erjia Ge; Guy Marks; Luke Knibbs

doi:10.1136/bmjopen-2023-082312

Long-term exposure to ambient fine particulate matter (PM_2.5) and attributable pulmonary tuberculosis notifications in Ningxia Hui Autonomous Region, China: a health impact assessment

BMJ Open. 2024 Jun 4;14(6):e082312. doi: 10.1136/bmjopen-2023-082312.

Authors

Igor Popovic^{1

2}, Ricardo Soares Magalhaes^{2

3}, Shukun Yang⁴, Yurong Yang⁵, Bo-Yi Yang⁶, Guang-Hui Dong⁷, Xiaolin Wei⁸, Joseph Van Buskirk^{9

10}, Gregory Fox¹¹, Erjia Ge¹², Guy Marks^{13

14}, Luke Knibbs^{15

16}

Affiliations

¹ Faculty of Medicine, School of Public Health, The University of Queensland, Herston, Queensland, Australia i.popovic@uqconnect.edu.au.
² UQ Spatial Epidemiology Laboratory, School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia.
³ Children's Health and Environment Program, UQ Children's Health Research Center, The University of Queensland, South Brisbane, Queensland, Australia.
⁴ Department of Radiology, The First People's Hospital in Yinchuan, The Second Affiliated Hospital of Ningxia Medical University, Yinchuan, Ningsia, China.
⁵ Department of Pathogenic Biology & Medical Immunology, School of Basic Medical Science, Ningxia Medical University, Yinchuan, Ningxia, China.
⁶ Environmental Epidemiology, Sun Yat-Sen University, Guangzhou, China.
⁷ Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-Sen University, Guangzhou, Guangdong, China.
⁸ Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
⁹ Public Health Unit, Sydney Local Health District, Camperdown, New South Wales, Australia.
¹⁰ School of Public Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia.
¹¹ Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
¹² University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada.
¹³ South Western Sydney Clinical School, University of New South Wales, The University of Sydney, Liverpool, New South Wales, Australia.
¹⁴ Woolcock Institute of Medical Research, Glebe, New South Wales, Australia.
¹⁵ Public Health Research Analytics and Methods for Evidence, Public Health Unit, Sydney Local Health District, Camperdown, New South Wales, Australia.
¹⁶ Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.

Abstract

Introduction: Long-term exposure to fine particulate matter (≤2.5 µm (PM_2.5)) has been associated with pulmonary tuberculosis (TB) notifications or incidence in recent publications. Studies quantifying the relative contribution of long-term PM_2.5 on TB notifications have not been documented. We sought to perform a health impact assessment to estimate the PM_2.5- attributable TB notifications during 2007-2017 in Ningxia Hui Autonomous Region (NHAR), China.

Methods: PM_2.5 attributable TB notifications were estimated at township level (n=358), stratified by age group and summed across NHAR. PM_2.5-associated TB-notifications were estimated for total and anthropogenic PM_2.5 mass and expressed as population attributable fractions (PAFs). The main analysis used effect and uncertainty estimates from our previous study in NHAR, defining a counterfactual of the lowest annual PM_2.5 (30 µg/m³) level, above which we assumed excess TB notifications. Sensitivity analyses included counterfactuals based on the 5th (31 µg/m³) and 25th percentiles (38 µg/m³), and substituting effect estimates from a recent meta-analysis. We estimated the influence of PM_2.5 concentrations, population growth and baseline TB-notification rates on PM_2.5 attributable TB notifications.

Results: Over 2007-2017, annual PM_2.5 had an estimated average PAF of 31.2% (95% CI 22.4% to 38.7%) of TB notifications while the anthropogenic PAF was 12.2% (95% CI 9.2% to 14.5%). With 31 and 38 µg/m³ as counterfactuals, the PAFs were 29.2% (95% CI 20.9% to 36.3%) and 15.4% (95% CI 10.9% to 19.6%), respectively. PAF estimates under other assumptions ranged between 6.5% (95% CI 2.9% to 9.6%) and 13.7% (95% CI 6.2% to 19.9%) for total PM_2.5, and 2.6% (95% CI 1.2% to 3.8%) to 5.8% (95% CI 2.7% to 8.2%) for anthropogenic PM_2.5. Relative to 2007, overall changes in PM_2.5 attributable TB notifications were due to reduced TB-notification rates (-23.8%), followed by decreasing PM2.5 (-6.2%), and population growth (+4.9%).

Conclusion: We have demonstrated how the potential impact of historical or hypothetical air pollution reduction scenarios on TB notifications can be estimated, using public domain, PM_2.5 and population data. The method may be transferrable to other settings where comparable TB-notification data are available.

Keywords: China; epidemiology; tuberculosis.

MeSH terms

Adolescent
Adult
Aged
Air Pollutants / adverse effects
Air Pollutants / analysis
Air Pollution / adverse effects
Child
Child, Preschool
China / epidemiology
Environmental Exposure* / adverse effects
Female
Health Impact Assessment
Humans
Incidence
Infant
Male
Middle Aged
Particulate Matter* / adverse effects
Particulate Matter* / analysis
Tuberculosis, Pulmonary* / epidemiology
Young Adult

Substances

Particulate Matter
Air Pollutants