Lagged Effects of Exposure to Air Pollutants on the Risk of Pulmonary Tuberculosis in a Highly Polluted Region

Background Although significant correlations have been observed between air pollutants and the development of pulmonary tuberculosis (PTB) in many developed countries, data are scarce for developing and highly polluted regions. Method A combined Poisson generalized linear regression-distributed lag nonlinear model was used to determine the associations between long-term exposure (2005-2017) to air pollutants and the risk of PTB in the Beijing-Tianjin-Hebei region. Results The monthly PTB cases exhibited a fluctuating downward trend. For each 10 μg/m 3 increase in concentration, the maximum lag-specific risk and cumulative relative risk (RR) were 1.011 (95% confidence interval (CI): 1.0091.012, lag: 3 months) and 1.042 (1.036-1.048, 5 months) for PM 2.5 , and 1.023 (1.015-1.031, 0 months) and 1.041 (1.026-1.055, 2 months) for NO 2 . The risk of PTB was negatively correlated with O 3 exposure, and the minimum lag-specific risk and cumulative RR were 0.991 (95% CI: 0.987-0.994, lag: 0 months) and 0.974 (0.968-0.981, 4 months), respectively. No age-dependent effects were observed. Conclusions Our results revealed potential associations between outdoor exposure to PM 2.5 , NO 2 , and O 3 and the risk of PTB. Further research should explore the corresponding interactions and potential mechanisms.