Background: Drug-resistant tuberculosis (DR-TB), diabetes and exposure to air pollution
are thought to be important threat to human health, but no studies have explored the
effects of ambient air pollutants on DR-TB when adjusting diabetes status so far.Methods:
We performed a study among 3759 newly diagnosed TB cases with drug-susceptibility
testing results, diabetes status, and individual air pollution data in Shandong from
2015 to 2019. Generalized linear mixed models (GLMM) including three models (Model
1: without covariates, Model 2: adjusted by diabetes status only, Model 3: with all
covariates) were applied.Results: Of 3759 TB patients enrolled, 716 (19.05%) were
DR-TB, and 333 (8.86%) had diabetes. High exposure to O-3 was associated with an increased
risk of RFP-resistance (Model 2 or 3: odds ratio (OR) = 1.008, 95% confidence intervals
(CI): 1.002-1.014), ethambutol-resistance (Model 3: OR = 1.015, 95%CI: 1.004-1.027)
and any rifampicin+streptomycin resistance (Model 1,2,3: OR = 1.01, 95%CI: 1.002-1.018)
at 90 days. In contrast, NO2 was associated with a reduced risk of DR-TB (Model 3:
OR = 0.99, 95%CI: 0.981-0.999) and multidrug-resistant TB (MDR-TB) (Model 3: OR =
0.977, 95%CI: 0.96-0.994) at 360 days. Additionally, SO2 (Model 1, 2, 3: OR = 0.987,
95%CI: 0.977-0.998) showed a protective effect on MDR-TB at 90 days. PM2.5 (90 days,
Model 2: OR = 0.991, 95%CI: 0.983-0.999), PM10 (360 days, Model 2: OR = 0.992, 95%CI:
0.985-0.999) had protective effects on any RFP+SM resistance.Conclusions: O-3 contributed
to an elevated risk of TB resistance but PM2.5, PM10, SO2, NO2 showed an inverse effect.
Air pollutants may affect the development of drug resistance among TB cases by adjusting
the status of diabetes.
