Study on the impact of common air pollution indicators on tuberculosis incidence in high-TB-burden countries worldwide

Objective To explore the effect of air pollution on tuberculosis (TB) in multiple countries and to provide a scientific reference for air pollution treatment and tuberculosis prevention and control. Methods Spearman's correlation analysis and generalized additive models of air pollution indicators and the annual incidence of tuberculosis in the top 20 countries with global tuberculosis incidence in 2021 were conducted to investigate the association effect between air pollution and tuberculosis incidence globally from 1990 to 2020. Results The severity of the global TB epidemic in 2021 varied widely among countries, and Spearman's correlation analyses showed a positive correlation between TB incidence and Household air pollution (HAP; r HAP = 0.476) and negative correlations between NO 2 , O 3 , PM, and Gross domestic product (GDP) and TB incidence (r NO2 = -0.622, r O3 = -0.419, r PM = -0.323, and r GDP = -0.477). By examining the effects of influencing factor interactions on the development of tuberculosis, it was found that at HAP 2 , and the risk of TB incidence increased at lower NO 2 (2-6 ppb) and O 3 Conclusion There is a synergistic amplification of the increase in TB incidence by HAP, O 3 , GDP, and NO 2 , with low NO 2 concentrations, low HAP, and high O 3 conditions favouring TB. The incidence of TB is adversely affected by air pollution to varying degrees across countries; therefore, countries can target preventive measures to reduce the risk of TB.