Outdoor environmental exposome and the burden of tuberculosis: Findings from nearly two million adults in northwestern China

Jia Xin Li, Qiyun Luan, Beibei Li, Shyamali C. Dharmage, Joachim Heinrich, Michael S. Bloom, Luke D. Knibbs, Igor Popovic, Li Li, Xuemei Zhong, Aimin Xu, Chuanjiang He, Kang Kang Liu, Xiao Xuan Liu, Gongbo Chen, Mingdeng Xiang, Yunjiang Yu, Yuming Guo, Guang Hui Dong, Xiaoguang ZouBo Yi Yang

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We simultaneously assessed the associations for a range of outdoor environmental exposures with prevalent tuberculosis (TB) cases in a population-based health program with 1940,622 participants ≥ 15 years of age. TB status was confirmed through bacteriological and clinical assessment. We measured 14 outdoor environmental exposures at residential addresses. An exposome-wide association study (ExWAS) approach was used to estimate cross-sectional associations between environmental exposures and prevalent TB, an adaptive elastic net model (AENET) was implemented to select important exposure(s), and the Extreme Gradient Boosting algorithm was subsequently applied to assess their relative importance. In ExWAS analysis, 12 exposures were significantly associated with prevalent TB. Eight of the exposures were selected as predictors by the AENET model: particulate matter ≤ 2.5 µm (odds ratio [OR]=1.01, p = 0.3295), nitrogen dioxide (OR=1.09, p < 0.0001), carbon monoxide (OR=1.19, p < 0.0001), and wind speed (OR=1.08, p < 0.0001) were positively associated with the odds of prevalent TB while sulfur dioxide (OR=0.95, p = 0.0017), altitude (OR=0.97, p < 0.0001), artificial light at night (OR=0.98, p = 0.0001), and proportion of forests, shrublands, and grasslands (OR=0.95, p < 0.0001) were negatively associated with the odds of prevalent TB. Air pollutants had higher relative importance than meteorological and geographical factors, and the outdoor environment collectively explained 11% of TB prevalence.

Original languageEnglish
Article number132222
Number of pages11
JournalJournal of Hazardous Materials
Publication statusPublished - 5 Oct 2023


  • Air pollutants
  • Geography
  • Meteorology
  • Outdoor environment
  • Tuberculosis

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