Association of ambient PM2.5 concentration with tuberculosis reactivation diseases -an integrated spatio-temporal analysis

Objectives: While the plausible role of ambient particulate matter (PM)2.5 exposure in tuberculosis (TB) reactivation has been inferred from in vitro experiments, epidemiologic evidence is lacking. We examined the relationship between ambient PM2.5 concentration and pulmonary TB (PTB) in an intermediate TB endemicity city dominated by reactivation diseases.Methods: Spatio-temporal analyses were performed on TB notification data and satellite-based annual mean PM2.5 concentration in Hong Kong. A total of 52,623 PTB cases from 2005-2018 were mapped to over 400 subdistrict units. PTB standardized notification ratio by population subgroups (elderly aged >= 65, middle-aged 50-64, and young adults aged 15-49) was calculated and correlated with ambient PM2.5 concentration.Results: Significant associations were detected between high ambient PM2.5 concentration and increased PTB among the elderly. Such associations were stable to the adjustment for socio-economic factors and other criteria pollutants. Unstable patterns of association between PM2.5 and PTB risk were observed in the middle-aged population and young adults, for which the observed associations were confounded by other criteria pollutants.Conclusion: With elderly PTB almost exclusively attributable to reactivation, our findings suggested that increased TB reactivations have occurred in association with high ambient PM2.5 exposure, lending support to preventive measures that minimize PM2.5-related TB reactivation.