空氣污染與結核病風險之世代研究

Abstract

背景 目前關於長期暴露於直徑小於或等於2.5微米的懸浮微粒（PM2.5）與結核病之間關係的證據有限且不一致。本研究旨在利用來自臺灣全國代表性樣本來調查兩者間的關聯性。 方法 我們對參加了2001年至2017年間五次全國健康訪問調查的12歲及以上個體進行了一項長期追蹤研究。每位參與者在發生結核病、死亡或2020年12月31日之前均進行了隨訪。個體基於ICD代碼和抗結核藥物處方被診斷為發生結核病。PM2.5暴露是使用空氣質量監測站和微型傳感器數據估計的。我們進行了時間相依的Cox迴歸分析，使用前兩年的平均PM2.5水平作為暴露窗口。受限制的立方曲線被用來檢驗非線性關聯。 結果 在追蹤時間中位數為11年的72180名個體中，報告了488例結核病病例。隨訪的第一年，平均PM2.5水平為31.0 μg/m3（標準差: 9.7 μg/m3）。調整性別、年齡、身體質量指數、吸菸、飲酒、教育程度、家庭平均月收入、居住在山地行政區、結核病病史和結核病的時間趨勢後，PM2.5年平均值每增加10 μg/m3 調整後的HR為0.94（CI: 0.84-1.05）。受限制的立方曲線Cox迴歸分析的結果顯示，PM2.5和結核病之間可能存在非線性關係（p-value for non-linearity: 0.084）。我們還觀察到年齡的效應修飾（p-value: 0.048），在65歲以上和65歲以下的個體之間結核病風險存在顯著差異。改變暴露窗口和結點選擇方法對主要結果影響有限。 結論 這項大型基於人口的世代研究結果顯示，PM2.5和結核病之間可能存在非線性關係，特別是在低濃度下呈現反向關係。老年族群可能是受空氣污染影響的易感族群。

Background Available evidence on the relationship between long-term exposure to particulate matter with aerodynamic diameter of ≤ 2.5 μm (PM2.5) and tuberculosis (TB) has been limited and inconsistent. This study aimed to investigate this association using a nationally representative sample from Taiwan. Methods We conducted a longitudinal cohort study on individuals aged ≥12 years who participated in 5 rounds of the National Health Interview Survey from 2001 to 2017. Participants were followed up until the incidence of active TB, death, or 31 December 2020. TB incidence was identified based on ICD codes and prescription of anti-TB drugs. PM2.5 exposure was estimated using air quality monitoring stations and microsensors data. Time-dependent Cox regression analyses were conducted, using the average PM2.5 level in the preceding two years as the exposure window. Nonlinear associations were examined using restricted cubic splines. Results Among 72,180 individuals with a median follow-up time of 11 years, 488 TB cases were reported. During the first year of follow-up, the mean PM2.5 level was 31.0 μg/m3 (SD: 9.7 μg/m3). After adjusting for sex, age, body mass index, cigarettes smoking, alcohol use, education level, household income, living in mountain administrative areas, TB history, and secular trend of TB, the adjusted HR was 0.94 (CI: 0.84-1.05) for every 10 μg/m3 increase with preceding two years average PM2.5 level. The results of the restricted cubic spline Cox regression analysis suggested a potential nonlinear relationship between PM2.5 and TB (p-value for non-linearity: 0.084). We also observed effect modification by age (p-value: 0.048), with a significant difference in TB risk between individuals aged above 65 years and those aged 65 years and below. Changing the exposure window and knot selection method had limited impact on the main findings. Conclusions In the large population-based cohort study, the results revealed a nonlinear relationship between PM2.5 and TB, particularly an inverse relationship at low levels. The elderly population might be the vulnerable subgroup for the effect of air pollution.