Abstract
The associations between ambient air pollutants and tuberculosis seasonality are unclear. We assessed the temporal cross-correlations between ambient air pollutants and tuberculosis seasonality. Monthly tuberculosis incidence data and ambient air pollutants (PM(2.5), PM(10), carbon monoxide (CO), nitrogen dioxide (NO(2)), ozone (O(3)), sulfur dioxide (SO(2))) and air quality index (AQI) from 2013 to 2017 in Shanghai were included. A cross-correlogram and generalized additive model were used. A 4-month delayed effect of PM(2.5) (0.55), PM(10) (0.52), SO(2) (0.47), NO(2) (0.40), CO (0.39), and AQI (0.45), and a 6-month delayed effect of O(3) (-0.38) on the incidence of tuberculosis were found. The number of tuberculosis cases increased by 8%, 4%, 18%, and 14% for a 10 μg/m(3) increment in PM(2.5), PM(10), SO(2), and NO(2); 4% for a 10 unit increment in AQI; 8% for a 0.1 mg/m(3) increment in CO; and decreased by 4% for a 10 μg/m(3) increment in O(3). PM(2.5) concentrations above 50 μg/m(3), 70 μg/m(3) for PM(10), 16 μg/m(3) for SO(2), 47 μg/m(3) for NO(2), 0.85 mg/m(3) for CO, and 85 for AQI, and O(3) concentrations lower than 95 μg/m(3) were positively associated with the incidence of tuberculosis. Ambient air pollutants were correlated with tuberculosis seasonality. However, this sort of study cannot prove causality.