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Yi-Jun Lin,1 Hsing-Chieh Lin,2 Ying-Fei Yang,2 Chi-Yun Chen,2 Min-Pei Ling,3 Szu-Chieh Chen,4,5 Wei-Yu Chen,6,7 Shu-Han You,8 Tien-Hsuan Lu,2 Chung-Min Liao2 1Institute of Food Safety and Health Risk Assessment, National Yang-Ming University, Taipei, Taiwan; 2Department of Bioenvironmental Systems Engineering, National Taiwan University, Taipei, Taiwan; 3Department of Food Science, National Taiwan Ocean University, Keelung City, Taiwan; 4Department of Public Health, Chung Shan Medical University, Taichung, Taiwan; 5Department of Family and Community Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan; 6Department of Biomedical Science and Environmental Biology, Kaohsiung Medical University, Kaohsiung, Taiwan; 7Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; 8Institute of Food Safety and Risk Management, National Taiwan Ocean University, Keelung City, TaiwanCorrespondence: Chung-Min LiaoDepartment of Bioenvironmental Systems Engineering, National Taiwan University, Taipei, Taiwan, ROCTel +886 2 3366 3475Email cmliao@ntu.edu.twBackground: Broad-scale evidence has shown the significant association between ambient air pollutants and the development of tuberculosis (TB). However, the impact of air quality on the risk of TB in Taiwan is still poorly understood.Objective: To develop a probabilistic integrated population-level risk assessment approach for evaluating the contribution of ambient air pollution exposure to the risk of TB development among different regions of Taiwan.Materials and methods: A Bayesian-based probabilistic risk assessment model was implemented to link exposure concentrations of various air pollutants quantified in a probabilistic manner with the population-based exposure-response models developed by using an epidemiological investigation.Results: The increment of the risk of TB occurred in a region with a higher level of air pollution, indicating a strong relationship between ambient air pollution exposures and TB incidences. Carbon monoxide (CO) exposure showed the highest population attributable fraction (PAF), followed by nitrogen oxides (NOX) and nitrogen dioxide (NO2) exposures. In a region with higher ambient air pollution, it is most likely (80% risk probability) that the contributions of CO exposure to development of TB were 1.6–12.2% (range of median PAFs), whereas NOX and NO2 exposures contributed 1.2–9.8% to developing TB.Conclusion: Our findings provide strong empirical support for the hypothesis and observations from the literature that poor air quality is highly likely to link aetiologically to the risk of TB. Therefore, substantial reductions in CO, NOX, and NO2 exposures are predicted to have health benefits to susceptible and latently infected individuals that provide complementary mitigation efforts in reducing the burden of TB. Considering that people continue to be exposed to both TB bacilli and ambient air pollutants, our approach can be applied for different countries/regions to identify which air pollutants contribute to a higher risk of TB in order to develop potential mitigation programs.Keywords: tuberculosis, ambient air pollution, exposure-response function, probabilistic risk assessment, population attributable fraction |
