Associations of ambient air pollutants with regional pulmonary tuberculosis incidence in the central Chinese province of Hubei: a Bayesian spatial-temporal analysis

BACKGROUND: Air pollution and pulmonary tuberculosis (PTB) are still serious worldwide problems, especially in areas of developing countries. Whether there is an association between high ambient air pollutant concentrations and PTB has not been fully explored. METHODS: Bayesian spatial-temporal models were constructed to analyse the association between ambient air pollutants (particulate matter with aerodynamic diameters of ≤10 μm (PM(10)), sulfur dioxide (SO(2)) and nitrogen dioxide (NO(2))) and PTB incidence, adjusting for socioeconomic covariates. We collected data on pulmonary TB, ambient air pollution (PM(10), SO(2) and NO(2)) concentrations and socioeconomic covariates from 17 prefectures in the central Chinese province of Hubei between Jan 1, 2006, and Dec 31, 2015. RESULTS: For every annual 10 μg/m(3) increase in SO(2), the relative risk (RR) of PTB incidence was 1.046 (95% credible interval [CI], 1.038–1.054) in the study area. Moreover, we found positive associations with each annual 10 μg/m(3) increase in ambient air pollutants (PM(10), SO(2) and NO(2)) in females but only with SO(2) in males. A significant association for each 10 μg/m(3) increase in SO(2) was observed in all the age groups, with a significant association for PM(10) only in children under 14 years of age. A significant response relationship was also observed at a 0–1 month moving average lag for each 10 μg/m(3) increase in SO(2). CONCLUSIONS: High ambient air pollution concentrations in areas of developing countries might increase the risk of regional PTB incidence, especially for women and young people. Precautions and protective measures and efforts to reduce ambient air pollutant concentrations should be strengthened in developing countries.