Impact of the synergistic effect of pneumonia and air pollutants on newly diagnosed pulmonary tuberculosis in southern Taiwan

Da-Wei Wu; Yu-Cheng Cheng; Chih-Wen Wang; Chih-Hsing Hung; Pei-Shih Chen; Stephen Chu-Sung Hu; Chun-Hung Richard Lin; Szu-Chia Chen; Chao-Hung Kuo

doi:10.1016/j.envres.2022.113215

Impact of the synergistic effect of pneumonia and air pollutants on newly diagnosed pulmonary tuberculosis in southern Taiwan

Environ Res. 2022 Sep;212(Pt B):113215. doi: 10.1016/j.envres.2022.113215. Epub 2022 Apr 1.

Authors

Da-Wei Wu¹, Yu-Cheng Cheng², Chih-Wen Wang³, Chih-Hsing Hung⁴, Pei-Shih Chen⁵, Stephen Chu-Sung Hu⁶, Chun-Hung Richard Lin⁷, Szu-Chia Chen⁸, Chao-Hung Kuo⁹

Affiliations

¹ Doctoral Degree Program, Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, 807, Taiwan; Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, 812, Taiwan; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 807, Taiwan; Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan.
² Department of Computer Science and Engineering, National Sun Yat-sen University, Kaohsiung, 80424, Taiwan.
³ Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, 812, Taiwan; Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan; Division of Hepatobiliary, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 807, Taiwan.
⁴ Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan; Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 807, Taiwan; Department of Pediatrics, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, 807, Taiwan.
⁵ Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan; Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, 807, Taiwan; Institute of Environmental Engineering, College of Engineering, National Sun Yat-Sen University, Kaohsiung, 804, Taiwan; Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, 807, Taiwan.
⁶ Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung, 807, Taiwan; Department of Dermatology, College of Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan; Department of Dermatology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, 807, Taiwan.
⁷ Department of Computer Science and Engineering, National Sun Yat-sen University, Kaohsiung, 80424, Taiwan. Electronic address: lin@cse.nsysu.edu.tw.
⁸ Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, 812, Taiwan; Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan; Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 807, Taiwan; Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan. Electronic address: scarchenone@yahoo.com.tw.
⁹ Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, 812, Taiwan; Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 807, Taiwan.

PMID: 35367429
DOI: 10.1016/j.envres.2022.113215

Abstract

Background: An increased incidence of pulmonary tuberculosis (PTB) among patients with pulmonary diseases exposed to air pollution has been reported.

Objective: To comprehensively investigate the association between pneumonia (PN) and air pollution with PTB through a large-scale follow-up study.

Methods: We conducted a retrospective study using data from the Kaohsiung Medical University Hospital Research Database and the Taiwan Air Quality Monitoring Database. We included adult patients with PN, PTB and other comorbidities according to ICD-9 codes. Control subjects without PN were matched by age, sex and ten comorbidities to each PN patient at a ratio of 4:1.

Results: A total of 82,590 subjects were included. The PTB incidence rate was significantly higher in the PN group (2,391/100,000) than in the control group (1,388/100,000). The crude hazard ratio (HR) of PN-associated PTB incidence decreased with time, and the overall 7 years the HR (95% confidence interval; CI) was 1.74 (1.55-1.96). The overall adjusted HR and 95% CI of PN-related PTB in the multivariate Cox regression analysis was 3.38 (2.98-3.84). In addition, there was a cumulative lag effect of all air pollutants within 30 days of exposure. The peak adjusted HRs for PTB were noted on the 3rd, 8th, 12th and 12th days of PM_2.5, O₃, SO₂ and NO exposure, respectively. The overall peak HRs (95% CI) of PM_2.5, O₃, SO₂ and NO were 1.145 (1.139-1.152), 1.153 (1.145-1.161), 1.909 (1.839-1.982) and 1.312 (1.259-1.367), respectively, and there was a synergistic effect with pneumonia on the risk of PTB.

Conclusions: A strong association was found between past episodes of PN and the future risk of PTB. In addition, air pollutants including PM_2.5, SO₂, O₃ and NO, together with previous episodes of PN, had both long-term and short-term impact on the incidence of PTB.

Keywords: Air pollutant; Pneumonia; Pulmonary tuberculosis; Synergistic effect.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Air Pollutants* / analysis
Air Pollutants* / toxicity
Air Pollution* / adverse effects
Air Pollution* / analysis
Environmental Exposure / adverse effects
Environmental Exposure / analysis
Follow-Up Studies
Humans
Particulate Matter / analysis
Pneumonia* / chemically induced
Pneumonia* / epidemiology
Retrospective Studies
Taiwan / epidemiology
Tuberculosis, Pulmonary* / epidemiology

Substances

Air Pollutants
Particulate Matter