Can greenspace modify the combined effects of multiple air pollutants on pulmonary tuberculosis treatment outcomes? An empirical study conducted in Zhejiang Province, China.
- Author:
Bo XIE
1
;
Maolin WU
1
;
Zhe PANG
1
;
Bin CHEN
2
Author Information
- Publication Type:Journal Article
- Keywords: Combined air pollutants; Combined effect; Effect modification; Greenspace; Pulmonary tuberculosis treatment
- MeSH: Humans; China/epidemiology*; Air Pollutants/analysis*; Tuberculosis, Pulmonary/drug therapy*; Particulate Matter/adverse effects*; Male; Female; Middle Aged; Environmental Exposure/analysis*; Ozone/adverse effects*; Adult; Sulfur Dioxide/adverse effects*; Treatment Outcome; Air Pollution/adverse effects*; Aged; Nitrogen Dioxide/adverse effects*; Young Adult; Adolescent
- From:Environmental Health and Preventive Medicine 2025;30():31-31
- CountryJapan
- Language:English
-
Abstract:
BACKGROUND:Evidence on the combined effects of air pollutants and greenspace exposure on pulmonary tuberculosis (PTB) treatment is limited, particularly in developing countries with high levels of air pollution.
OBJECTIVE:We aimed to examine the individual and combined effects of long-term exposure to air pollutants on PTB treatment outcomes while also investigating the potential modifying effect of greenspace.
METHODS:This population-based study included 82,784 PTB cases notified in Zhejiang Province, China, from 2015 to 2019. The 24-month average concentrations of particulate matter with an aerodynamic diameter ≤2.5 µm (PM2.5), ozone (O3), nitrogen dioxide (NO2), and sulfur dioxide (SO2) before PTB diagnosis were estimated using a dataset derived from satellite-based machine learning models and monitoring stations. Greenspace exposure was assessed using the annual China Land Cover Dataset. We conducted analyses using time-varying Cox proportional hazards models and cumulative risk indices.
RESULTS:In individual effect models, each 10 µg/m3 increase in PM2.5, NO2, O3, and SO2 concentrations was associated with hazard ratios for PTB treatment success of 0.95 (95% confidence interval (CI): 0.93-0.97), 0.92 (95% CI: 0.91-0.94), 0.98 (95% CI: 0.97-0.99), and 1.52 (95% CI: 1.49-1.56), respectively. In combined effect models, long-term exposure to the combination of air pollutants was negatively associated with PTB treatment success, with a joint hazard ratio (JHR) of 0.79 (95% CI: 0.63-0.96). Among the pollutants examined, O3 contributed the most to the increased risks, followed by PM2.5 and NO2. Additionally, areas with moderate levels of greenspace showed a reduced risk (JHR = 0.81, 95% CI: 0.62-0.98) compared with the estimate from the third quantile model (JHR = 0.68, 95% CI: 0.52-0.83).
CONCLUSIONS:Combined air pollutants significantly impede successful PTB treatment outcomes, with O3 and PM2.5 accounting for nearly 75% of this detrimental effect. Moderate levels of greenspace can mitigate the adverse effects associated with combined air pollutants, leading to improved treatment success for patients with PTB.
