Lagged Effects of Exposure to Air Pollutants on the Risk of Pulmonary Tuberculosis in a Highly Polluted Region

Background: Although significant correlations have been observed between air pollutants and the development of pulmonary tuberculosis (PTB) in many developed countries, data are scarce for developing and highly polluted regions. Method: A combined Poisson generalized linear regression–distributed lag nonlinear model was used to determine the associations between long-term exposure (2005–2017) to air pollutants and the risk of PTB in the Beijing–Tianjin–Hebei region. Results: The monthly PTB cases exhibited a fluctuating downward trend. For each 10 μg/m(3) increase in concentration, the maximum lag-specific risk and cumulative relative risk (RR) were 1.011 (95% confidence interval (CI): 1.0091.012, lag: 3 months) and 1.042 (1.036–1.048, 5 months) for PM(2.5), and 1.023 (1.015–1.031, 0 months) and 1.041 (1.026–1.055, 2 months) for NO(2). The risk of PTB was negatively correlated with O(3) exposure, and the minimum lag-specific risk and cumulative RR were 0.991 (95% CI: 0.987–0.994, lag: 0 months) and 0.974 (0.968–0.981, 4 months), respectively. No age-dependent effects were observed. Conclusions: Our results revealed potential associations between outdoor exposure to PM(2.5), NO(2), and O(3) and the risk of PTB. Further research should explore the corresponding interactions and potential mechanisms.