# Study on the impact of common air pollution indicators on tuberculosis incidence in high-TB-burden countries worldwide

## TL;DR

This study examines how air pollution affects tuberculosis rates in countries with high TB burdens, finding that certain pollutants and economic factors are linked to increased TB incidence.

## Contribution

The study identifies synergistic effects of household air pollution, NO2, O3, and GDP on tuberculosis incidence in high-burden countries.

## Key findings

- Household air pollution and low NO2 levels are positively correlated with higher TB incidence.
- Low ozone levels and high GDP are negatively associated with TB incidence.
- Air pollution and economic factors interact to amplify TB risk in certain conditions.

## Abstract

To explore the effect of air pollution on tuberculosis (TB) in multiple countries and to provide a scientific reference for air pollution treatment and tuberculosis prevention and control.

Spearman’s correlation analysis and generalized additive models of air pollution indicators and the annual incidence of tuberculosis in the top 20 countries with global tuberculosis incidence in 2021 were conducted to investigate the association effect between air pollution and tuberculosis incidence globally from 1990 to 2020.

The severity of the global TB epidemic in 2021 varied widely among countries, and Spearman’s correlation analyses showed a positive correlation between TB incidence and Household air pollution (HAP; rHAP = 0.476) and negative correlations between NO2, O3, PM, and Gross domestic product (GDP) and TB incidence (rNO2 = −0.622, rO3 = −0.419, rPM = −0.323, and rGDP = −0.477). By examining the effects of influencing factor interactions on the development of tuberculosis, it was found that at HAP < 0.2, TB incidence tended to increase with increasing NO2, and the risk of TB incidence increased at lower NO2 (2–6 ppb) and O3 < 40 μg/m3.

There is a synergistic amplification of the increase in TB incidence by HAP, O3, GDP, and NO2, with low NO2 concentrations, low HAP, and high O3 conditions favouring TB. The incidence of TB is adversely affected by air pollution to varying degrees across countries; therefore, countries can target preventive measures to reduce the risk of TB.