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  • Title: Ambient sulfur dioxide levels associated with reduced risk of initial outpatient visits for tuberculosis: A population based time series analysis.
    Author: Ge E, Fan M, Qiu H, Hu H, Tian L, Wang X, Xu G, Wei X.
    Journal: Environ Pollut; 2017 Sep; 228():408-415. PubMed ID: 28554030.
    Abstract:
    BACKGROUND: Recent biochemical studies suggest that exogenous sulfur dioxide (SO2) at low concentrations may have been beneficial in inhibiting mycobacteria tuberculosis (TB) growth. However, there is a dearth of population-based studies. OBJECTIVES: To examine the association of ambient SO2 levels and initial TB outpatient visits. METHODS: In Ningbo, China, we collected all daily initial outpatient visits for TB and routinely air pollution monitoring data between January 2009 and December 2013. A time-series study was conducted by using generalized additive regression (GAM) with log-linear Poisson models to estimate the associations between daily initial TB outpatient visits and daily average concentration of SO2. Other traffic-related co-pollutants were adjusted. Sensitivity analyses were conducted to examine the relationship when 1% extreme SO2 concentrations excluded or if related to the early onsets of TB symptoms. RESULTS: SO2 concentrations in Ningbo were low with a daily average of 25 μg/m3 (i.e. 0.0089 ppm). Negative associations were identified between ambient SO2 concentrations and daily initial TB outpatient visits. A 10 μg/m3 increase in SO2 at lag3 and lag0-3 days were associated with -2.0% (95%CI, -3.2, -0.8) and -4.6% (95%CI, -6.8, -2.4) changes, respectively, in initial TB outpatient visits according to single-pollutant models. The negative association became stronger when nitrogen dioxide (NO2) or particulate matter with aerodynamic diameter less than 10 μm (PM10) was adjusted in two-pollutant models. This association was higher in males vs. females and in middle-aged adults vs. the elderly. We found a stronger negative association between SO2 concentration and the initial symptom occurrence. CONCLUSION: Short-term exposure to ambient SO2 was associated with reduced risk of initial TB outpatient visits, suggesting acute protective effects of low-level ambient SO2 exposure on bacteria-induced pulmonary infections.
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