Epidemiology and Health

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Effects of particulate air pollution on tuberculosis development in seven major cities of Korea from 2010 to 2016: methodological considerations involving long-term exposure and time lag: Honghyok Kim, Sarah Yu, Hongjo Choi; Epidemiol Health. 2020;42:e2020012. Published online March 12, 2020; DOI: https://doi.org/10.4178/epih.e2020012

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Abstract

OBJECTIVES
Epidemiological evidence of associations between ambient particulate matter (PM) and tuberculosis (TB) risk is accumulating. Two previous studies in Korea found associations between air pollution—especially sulfur dioxide (SO₂)—and TB. In this study, we conducted an annual time-series cross-sectional study to assess the effect of PM with an aerodynamic diameter less than 10 μm (PM₁₀) on TB risk in seven major cities of Korea from 2010 to 2016, taking into account time lag and long-term cumulative exposure.

METHODS

Age-standardized TB notification rates were derived using the Korea National TB Surveillance System. Annual average PM₁₀ concentrations were obtained from annual Korean air quality reports. We applied a generalized linear mixed model with unconstrained distributed lags of exposure to PM₁₀. We adjusted for potential confounders such as age, health behaviors, and area-level characteristics.

RESULTS

Both average annual PM₁₀ concentrations and age-standardized TB notification rates decreased over time. The association between cumulative exposure to PM₁₀ and TB incidence became stronger as a longer exposure duration was considered. An increase of one standard deviation (5.63 μg/m³) in PM₁₀ exposure for six years was associated with a 1.20 (95% confidence interval, 1.17 to 1.22) times higher TB notification rate. The marginal association of exposure duration with the TB notification rate was highest at four and five years prior to TB notification. This association remained consistent even after adjusting it for exposure to SO₂.

CONCLUSIONS

The findings of this study suggest that cumulative exposure to PM₁₀ may affect TB risk, with a potential lag effect.

Summary

Korean summary
국외 연구에서 미세먼지와 결핵발생의 관련성이 종종 보고되지만, 기존의 국내 연구에서는 관련성이 없는 것으로 알려져 있다. 본 연구는 미세먼지 노출의 누적효과와 결핵발생과의 시차에 주목하여 수행했다. 연구결과 미세먼지의 누적 노출 효과가 시간적 격차는 결핵발생률과 관련이 확인되었으며, 향후 연구에서도 이와 같은 방법론적 고려가 필요하겠다

Key Message

Citations

Citations to this article as recorded by

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