{"title":"A mediation analysis of meteorological factors on the association between ambient carbon monoxide and tuberculosis outpatients visits.","authors":"Tianfeng He, Xujun Qian, Jing Huang, Guoxing Li, Xinbiao Guo","doi":"10.3389/fpubh.2025.1526325","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Ambient carbon monoxide (CO) exposure has been identified as an emerging environmental risk factor contributing to the progression of pulmonary tuberculosis (PTB). However, the epidemiological evidence remains inconsistent. This study aims to investigate the short-term association between low-level CO exposure and PTB outpatient visits in a developing region.</p><p><strong>Methods: </strong>We conducted a time-series study utilizing a distributed lag non-linear model (DLNM) combined with mediating effect analysis, based on daily CO and PTB cases from 2011 to 2020 in Ningbo, China.</p><p><strong>Results: </strong>Among all patients with PTB, a 0.1 mg/m<sup>3</sup> increase in CO concentration was associated with an increased risk of PTB outpatient visits in the single-pollutant model, particularly at lag days 2-6. The maximum relative risk (<i>RR</i>) was 1.091 (95%CI, 1.020-1.168, lag 0-2 days). Similarly, the maximum cumulative lag effect of CO exposure was 1.781 (<i>RR</i> = 1.781, 95%CI: 1.157-2.742, lag 0-15 days). Subgroup analysis revealed a significant effect of CO exposure in males (<i>RR</i> = 1.090, 95%CI: 1.009-1.777, lag 0-3 days), females (<i>RR</i> = 1.101, 95%CI: 1.014-1.195, lag 0-3 days), younger individuals (<i>RR</i> = 1.097, 95%CI: 1.022-1.178, lag 0-2 days), and during the warm season (<i>RR</i> = 1.012, 95%CI: 1.002-1.022, lag 0-4 days). Mediation analysis indicated that temperature had an indirect mediating effect on association between CO and PTB (-0.0065, 95%CI: -0.0130 to -0.0004), while air pressure, visibility, and humidity showed no significant mediating effects.</p><p><strong>Conclusion: </strong>Our findings indicate that ambient CO exposure, even at low levels, has a short-term impact on PTB in developing regions. Temperature plays a partial mediating role in this relationship. Consequently, it is critical to enhance environmental monitoring and early warning systems to effectively address the prevalence of PTB and the delays in health-seeking behavior.</p>","PeriodicalId":12548,"journal":{"name":"Frontiers in Public Health","volume":"13 ","pages":"1526325"},"PeriodicalIF":3.0000,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11841497/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Frontiers in Public Health","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3389/fpubh.2025.1526325","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Ambient carbon monoxide (CO) exposure has been identified as an emerging environmental risk factor contributing to the progression of pulmonary tuberculosis (PTB). However, the epidemiological evidence remains inconsistent. This study aims to investigate the short-term association between low-level CO exposure and PTB outpatient visits in a developing region.
Methods: We conducted a time-series study utilizing a distributed lag non-linear model (DLNM) combined with mediating effect analysis, based on daily CO and PTB cases from 2011 to 2020 in Ningbo, China.
Results: Among all patients with PTB, a 0.1 mg/m3 increase in CO concentration was associated with an increased risk of PTB outpatient visits in the single-pollutant model, particularly at lag days 2-6. The maximum relative risk (RR) was 1.091 (95%CI, 1.020-1.168, lag 0-2 days). Similarly, the maximum cumulative lag effect of CO exposure was 1.781 (RR = 1.781, 95%CI: 1.157-2.742, lag 0-15 days). Subgroup analysis revealed a significant effect of CO exposure in males (RR = 1.090, 95%CI: 1.009-1.777, lag 0-3 days), females (RR = 1.101, 95%CI: 1.014-1.195, lag 0-3 days), younger individuals (RR = 1.097, 95%CI: 1.022-1.178, lag 0-2 days), and during the warm season (RR = 1.012, 95%CI: 1.002-1.022, lag 0-4 days). Mediation analysis indicated that temperature had an indirect mediating effect on association between CO and PTB (-0.0065, 95%CI: -0.0130 to -0.0004), while air pressure, visibility, and humidity showed no significant mediating effects.
Conclusion: Our findings indicate that ambient CO exposure, even at low levels, has a short-term impact on PTB in developing regions. Temperature plays a partial mediating role in this relationship. Consequently, it is critical to enhance environmental monitoring and early warning systems to effectively address the prevalence of PTB and the delays in health-seeking behavior.
期刊介绍：
Frontiers in Public Health is a multidisciplinary open-access journal which publishes rigorously peer-reviewed research and is at the forefront of disseminating and communicating scientific knowledge and impactful discoveries to researchers, academics, clinicians, policy makers and the public worldwide. The journal aims at overcoming current fragmentation in research and publication, promoting consistency in pursuing relevant scientific themes, and supporting finding dissemination and translation into practice.
Frontiers in Public Health is organized into Specialty Sections that cover different areas of research in the field. Please refer to the author guidelines for details on article types and the submission process.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
