Traffic-Related Air Pollution and All-Cause Mortality during Tuberculosis Treatment in California.
Traffic-Related Air Pollution and All-Cause Mortality during Tuberculosis Treatment in California.
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DOI：
10.1289/ehp1699
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发表时间：
2017-09-29
影响因子：
10.4
通讯作者：
Nahid P
中科院分区：
文献类型：
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作者：
Blount RJ;Pascopella L;Catanzaro DG;Barry PM;English PB;Segal MR;Flood J;Meltzer D;Jones B;Balmes J;Nahid P
环境空气污染和结核病（TB）对全世界的公共卫生都有影响，但两者之间的联系仍然不确定。我们确定了活动性结核病治疗期间居民交通对死亡率的影响。从2000年到2012年，我们在加州招募了32,875名活动性结核病患者，并在整个治疗过程中对他们进行了随访。我们从加州结核病登记处获得了患者数据，并计算了住宅地址周围半径缓冲区的交通量和交通密度。我们使用考克斯模型来确定死亡率风险比，控制人口统计学、社会经济学和临床潜在混杂因素。我们将交通风险分类为五分位数，并使用Wald检验确定趋势。参与者贡献了22，576人-年的风险。治疗期间有2 305人死亡，粗死亡率为每10 000人年1 021人死亡。患者住所周围所有缓冲区的交通量和交通密度与结核病治疗期间死亡率的增加相关，尽管在所有缓冲区中的研究结果并不具有统计学意义。随着缓冲区规模的减少，五分之一的死亡风险增加，交通风险的五分之一的趋势在统计上变得更加重要。缓冲区最近道路交通量的增加与结核病治疗期间死亡风险增加3%、14%、19%和28%相关[第一个五分位数，参考;第二个五分位数风险比[95%置信区间（CI）：0.86，1.25];第三个五分位数（95% CI：0.95，1.37）;第四个五分位数（95% CI：0.99，1.43）;第五个五分位数（95% CI：1.07，1.53）; ]。即使在调整了多种人口统计学、社会经济学和临床因素后，居住地接近道路交通量和交通密度与接受活动性结核病治疗的患者的全因死亡率增加相关，这表明结核病患者易受交通相关空气污染的不良健康影响。https://doi.org/10.1289/EHP1699
Ambient air pollution and tuberculosis (TB) have an impact on public health worldwide, yet associations between the two remain uncertain. We determined the impact of residential traffic on mortality during treatment of active TB. From 2000–2012, we enrolled 32,875 patients in California with active TB and followed them throughout treatment. We obtained patient data from the California Tuberculosis Registry and calculated traffic volumes and traffic densities in to radius buffers around residential addresses. We used Cox models to determine mortality hazard ratios, controlling for demographic, socioeconomic, and clinical potential confounders. We categorized traffic exposures as quintiles and determined trends using Wald tests. Participants contributed 22,576 person-years at risk. There were 2,305 deaths during treatment for a crude mortality rate of 1,021 deaths per 10,000 person-years. Traffic volumes and traffic densities in all buffers around patient residences were associated with increased mortality during TB treatment, although the findings were not statistically significant in all buffers. As the buffer size decreased, fifth-quintile mortality hazards increased, and trends across quintiles of traffic exposure became more statistically significant. Increasing quintiles of nearest-road traffic volumes in the buffer were associated with 3%, 14%, 19%, and 28% increased risk of death during TB treatment [first quintile, referent; second quintile hazard ratio [95% confidence interval (CI): 0.86, 1.25]; third quintile (95% CI: 0.95, 1.37); fourth quintile (95% CI: 0.99, 1.43); fifth quintile (95% CI: 1.07, 1.53), respectively; ]. Residential proximity to road traffic volumes and traffic density were associated with increased all-cause mortality in patients undergoing treatment for active tuberculosis even after adjusting for multiple demographic, socioeconomic, and clinical factors, suggesting that TB patients are susceptible to the adverse health effects of traffic-related air pollution. https://doi.org/10.1289/EHP1699