A systematic review and meta-analysis on the association between ambient air pollution and pulmonary tuberculosis

Abstract

There is inconclusive evidence on the association between ambient air pollution and pulmonary tuberculosis (PTB) incidence, tuberculosis-related hospital admission and mortality. This review aimed to assess the extent to which selected air pollutants are associated to PTB incidence, hospital admissions and mortality. This was a systematic review of studies published in English from January 1st, 1946, through May 31st, 2022, that quantitatively assessed the association between PM2.5, PM10, NO2, SO2, CO, O3 and the incidence of, hospital admission or death from PTB. Medline, Embase, Scopus and The Cochrane Library were searched. Extracted data from eligible studies were analysed using STATA software. Random-effect meta-analysis was used to derive pooled adjusted risk and odds ratios. A total of 24 studies (10 time-series, 5 ecologic, 5 cohort, 2 case–control, 1 case cross-over, 1 cross-sectional) mainly from Asian countries were eligible and involved a total of 437,255 tuberculosis cases. For every 10 μg/m3 increment in air pollutant concentration, there was a significant association between exposure to PM2.5 (pooled aRR = 1.12, 95% CI: 1.06–1.19, p < 0.001, N = 6); PM10 (pooled aRR = 1.06, 95% CI: 1.01–1.12, p = 0.022, N = 8); SO2 (pooled aRR = 1.08, 95% CI: 1.04–1.12, p < 0.001, N = 9); and the incidence of PTB. There was no association between exposure to CO (pooled aRR = 1.04, 95% CI: 0.98–1.11, p = 0.211, N = 4); NO2 (pooled aRR = 1.08, 95% CI: 0.99–1.17, p = 0.057, N = 7); O3 (pooled aRR = 1.00, 95% CI: 0.99–1.02, p = 0.910, N = 6) and the incidence of PTB. There was no association between the investigated air pollutants and mortality or hospital admissions due to PTB. Overall quality of evidence was graded as low (GRADE approach). Exposure to PM2.5, PM10 and SO2 air pollutants was found to be associated with an increased incidence of PTB, while exposure to CO, NO2 and O3 was not. There was no observed association between exposure to these air pollutants and hospital admission or mortality due to PTB. The quality of the evidence generated, however, remains low. Addressing the tuberculosis epidemic by 2030 as per the 4th Sustainable Development Goal may require a more rigorous exploration of this association.

A systematic review and meta-analysis of the association between air pollutants and the incidence of tuberculosis

“…For example, Kun et al’s study showed that chronic exposure to PM 10 , nitrogen dioxide, and sulfur dioxide promoted the development of TB, whereas the relationship between PM 2.5 , ozone, and nitrous oxide and the development of TB was not so precise [ 24 ]. Dimala et al used a random effects model to investigate the relationship between PM 2.5 , PM 10 , CO, sulfur dioxide, nitrogen dioxide, and ozone and the incidence of TB, and their results indicated that the first three pollutants were positively associated with the incidence of TB, while the last three were not associated with the incidence of TB [ 25 ].…”

Interrelationships between tuberculosis and chronic obstructive pulmonary disease

“…Several studies have linked ambient air pollution to poor TB outcomes. A recent meta-analysis including 24 studies determined that multiple air pollutants were associated with active TB [49]. Every 10 μg/m 3 increase in air pollutant concentration increased the risk for active TB incidence: for PM 2.5 , pooled aRR = 1.12 (95% CI, 1.06–1.19); for PM 10 , pooled aRR = 1.06 (95% CI, 1.01–1.12); and for sulfur dioxide, pooled aRR = 1.08 (95% CI, 1.04–1.12).…”

Pivotal relationship between heavy metal, PM2.5exposures and tuberculosis in Bangladeshi children: protocol paper of a case–control study

“…This paper describes the design of a patient-oriented pilot study which seeks to uncover the association between environmental heavy metals and TB. The rationale for the proposed study builds on existing research, highlighting that exposure to PM is significantly associated with an increased incidence of pulmonary TB (PTB) in adults 12. However, the current body of evidence is limited on the environmental risks for children in Bangladesh.…”

“…The rationale for the proposed study builds on existing research, highlighting that exposure to PM is significantly associated with an increased incidence of pulmonary TB (PTB) in adults. 12 However, the current body of evidence is limited on the environmental risks for children in Bangladesh. Furthermore, significantly greater progress is required to achieve the UN Sustainable Development Goal, target 3.3, to end TB epidemics by 2030.…”