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Investigation of Indoor Solid Fuel and Kerosene Use as Tuberculosis Risk Factors

室内固体燃料和煤油使用作为结核病危险因素的调查

基本信息

批准号：
8826119
负责人：
MICHAEL N BATES
金额：
$ 57.91万
依托单位：
UNIVERSITY OF CALIFORNIA BERKELEY
依托单位国家：
美国
项目类别：
财政年份：
2011
资助国家：
美国
起止时间：
2011-08-16 至 2017-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8826119
关键词：
AIDS/HIV problem Affect Agriculture Air Alcohol consumption Area Asia Biological Assay Biomass Budgets Burn injury Case-Control Studies Cattle Communicable Diseases Complex Cost-Benefit Analysis Country Crowding Data Data Analyses Developed Countries Developing Countries Development Disease Drug resistance in tuberculosis Environmental air flow Exposure to Extreme drug resistant tuberculosis Family history of Fossil Fuels Frequencies Government HIV Infections Health Policy Heating Home heating Hospitals Household Housing Immigration Immune system Impairment Indoor Air Pollution Infection Interferons International International Agencies Intervention Investigation Kerosene Life Lighting Lung diseases Malnutrition Measurement Methodology Modeling Mycobacterium tuberculosis Nepal Newly Diagnosed Odds Ratio Participant Particulate Matter Petroleum Policies Population Predisposition Prevalence Questionnaires Recruitment Activity Relative Risks Risk Risk Factors Selection Bias Smoke T-Lymphocyte Testing Time Tobacco smoking Tobacco use Travel Tuberculin Test Tuberculosis Wood material Work base biomass fuel biomass smoke combustion product cooking disorder risk indoor exposure interest latent infection modifiable risk mortality policy implication solid fuel systematic review wasting

项目摘要

DESCRIPTION (provided by applicant): Among infectious diseases, tuberculosis (TB) is second only to HIV/AIDS in causing mortality. About one-third of the world's population have TB infection. Most infected people never develop active TB, but form a reservoir of latent infections that can progress to become active disease. Therefore, modifiable risk factors for TB infection or for progress from infection to active TB need to be identified. The most common fuel for heating and cooking in developing countries is biomass (wood, cow dung and agricultural waste), often burnt without any chimney or ventilation. Houses fill with smoke. Whether biomass smoke increases TB risk is uncertain. Our previous work, a TB case-control study in Nepal, found indoor biomass burning as a heating fuel, and use of kerosene, for cooking or lighting, to be likely strong risk factors for TB disease. Whether kerosene use is a TB risk factor has not been investigated before. However, there is the possibility that selection bias was responsible for our results. Therefore, we propose a further case-control study of TB using a more rigorous control selection methodology, while collecting more extensive exposure data for indoor fuel use. We will also identify the controls with latent TB infection, using T-cell-based interferon-3 release assays and use the latent TB-positive controls in a separate set of data analyses. Over 3.25 years, we will recruit 650 newly diagnosed TB cases from the Pokhara Regional TB Center, Nepal, and 1300 frequency-matched controls selected from the village areas in which the cases live. Each participant will be administered a questionnaire on fuel use for cooking, heating and lighting, as well as seeking information on other potential TB risk factors. All the controls will be tested for latent TB infection. Measurements of air exchange rates (AER) and CO and particulate matter emissions will be obtained from nearly one-quarter of the study households (n=450). We will use the measurement data to model AERs and emission levels in the households where actual measurements are not made. In addition to the data analyses using all controls, we will carry out a parallel set of analyses using only the controls who are positive for TB infection. Division of the odds ratio (OR) obtained using all controls by the corresponding OR obtained using just latently infected controls will provide an estimate of the relative risk for TB infection. Data analysis will focus on identifying whether kerosene or biomass, as heating, lighting or cooking fuels, are risk factors for TB disease or infection. Findings showing either biomass or kerosene fuel to be risk factors, will have major implications for health policy and interventions. If kerosene is a risk factor, then this will provide justification for not treating it as a clean fuel alternative to biomass, as is currently the policy of some international agencies.

描述（由申请人提供）：在传染病中，结核病（TB）是仅次于艾滋病毒/艾滋病的第二大死亡原因。世界上大约三分之一的人口感染结核病。大多数感染者不会发展为活动性结核病，但会形成一个潜伏感染的水库，可以发展为活动性疾病。因此，需要确定结核感染或从感染进展为活动性结核的可改变的风险因素。在发展中国家，最常见的取暖和做饭燃料是生物质（木材、牛粪和农业废物），燃烧时往往没有任何烟囱或通风。房子充满了烟雾。生物质烟雾是否会增加结核病风险尚不确定。我们以前的工作，在尼泊尔进行的结核病病例对照研究，发现室内生物质燃烧作为取暖燃料，以及使用煤油做饭或照明，可能是结核病的强烈风险因素。煤油使用是否是结核病的危险因素以前没有调查过。然而，有可能是选择偏差导致了我们的结果。因此，我们建议使用更严格的对照选择方法进行进一步的结核病病例对照研究，同时收集更广泛的室内燃料使用暴露数据。我们还将使用基于T细胞的干扰素-3释放测定来鉴定具有潜伏性TB感染的对照，并在单独的一组数据分析中使用潜伏性TB阳性对照。在3.25年的时间里，我们将从尼泊尔博卡拉地区结核病中心招募650名新诊断的结核病病例，并从病例居住的村庄地区选择1300名频率匹配的对照。每位参与者将收到一份关于烹饪、取暖和照明燃料使用的问卷，并寻求有关其他潜在结核病风险因素的信息。将对所有对照品进行潜伏性TB感染检测。空气交换率（AER）和CO和颗粒物排放量的测量将获得近四分之一的研究家庭（n=450）。我们将使用测量数据来模拟未进行实际测量的家庭的AER和排放水平。除了使用所有对照的数据分析外，我们将仅使用TB感染阳性的对照进行一组平行分析。用所有对照组获得的比值比（OR）除以仅用潜伏感染对照组获得的相应OR，将提供TB感染相对风险的估计值。数据分析将侧重于确定煤油或生物质作为取暖、照明或烹饪燃料是否是结核病或感染的风险因素。研究结果表明，生物质或煤油燃料是危险因素，将对卫生政策和干预措施产生重大影响。如果煤油是一个危险因素，那么这就为不将其作为生物量的清洁燃料替代品提供了理由，而这正是一些国际机构目前的政策。