Associations of residential greenness exposure and ambient air pollutants with newly-diagnosed drug-resistant tuberculosis cases

• Published in: Environmental science and pollution research international 2024-04, Vol.31 (18), p.27240-27258
• Main Authors: Song, Wan-mei, Liu, Yi, Men, Dan, Li, Shi-jin, Tao, Ning-ning, Zhang, Qian-yun, Liu, Si-qi, An, Qi-qi, Zhu, Xue-han, Han, Qi-lin, Zhang, Yu-zhen, Li, Ying-ying, Li, Chun-xiao, Liu, Yao, Yu, Chun-bao, Li, Yi-fan, Li, Huai-chen
• Format: Article
• Language: English
• Subjects: Adult; Air Pollutants; Air Pollution; Aquatic Pollution; Atmospheric Protection/Air Quality Control/Air Pollution; Body mass index; Body size; Buffers; China; Confidence intervals; Drug resistance; Earth and Environmental Science; Ecotoxicology; Environment; Environmental Chemistry; Environmental Exposure; Environmental Health; Ethambutol; Exposure; Female; Humans; Isoniazid; Male; Middle Aged; Multidrug resistance; Nitrogen dioxide; Normalized difference vegetative index; Particulate matter; Pollutants; Population density; Regression analysis; Regression models; Research Article; Rifampin; Risk reduction; Statistical analysis; Streptomycin; Sulfur dioxide; Tuberculosis; Tuberculosis, Multidrug-Resistant; Waste Water Technology; Water Management; Water Pollution Control
• ISSN: 1614-7499; 0944-1344; 1614-7499
• DOI: 10.1007/s11356-024-32913-x

Growing evidence has found the health protective effects of greenness exposure on tuberculosis (TB) and the impact of ambient air pollutants on TB drug-resistance. However, it remains unclear whether residential greenness is also beneficial to reduce TB drug-resistance, and whether air pollution modify the greenness-TB resistance relationship. We enrolled 5006 newly-diagnosed TB patients from Shandong, China, during 2014 to 2021. Normalized Difference Vegetation Index (NDVI) in 250 m and 500 m buffer around individuals’ residential zone was used to assess greenness exposure. All patients were divided by quartiles of NDVI 250-m and NDVI 500-m (from low to high: Q1, Q2, Q3, Q4) respectively. Six logistic regression models (NDVI, NDVI + PM 2.5 /PM 10 /SO 2 /NO 2 /O 3 ) were used to estimate the association of NDVI and TB drug-resistance when adjusting different air pollutants or not. All models were adjusted for age, gender, body mass index, complications, smoking, drinking, population density, nighttime light index, road density. Compared with participants in NDVI 250-m Q1 and NDVI 500-m Q1, other groups had lower rates of MDR-TB, PDR-TB, RFP-resistance, SM-resistance, RFP + SM resistance, INH + RFP + EMB + SM resistance. NDVI 500-m reduced the risk of multidrug resistant tuberculosis (MDR-TB) and the adjusted odds ratio (aOR, 95% confidence interval, CI) compared with NDVI 500-m Q1 were 0.736 (0.547–0.991) in NDVI + PM 10 model, 0.733 (0.544–0.986) in NDVI + PM 2.5 model, 0.735(0.546–0.99) in NDVI + SO 2 model, 0.736 (0.546–0.991) in NDVI + NO2 model, respectively, P