Spatiotemporal Inequalities in the Burden of Tuberculosis Attributable to Long-Term Particulate Matter Exposure in Mainland of China.

Long-term exposure to particulate matter (PM) pollution may directly increase the risk of developing tuberculosis (TB). Despite the known link, the multi-scale spatiotemporal variations in the burden of TB attributable to long-term PM exposure remain largely unclear in China. In this study, we conducted a nationwide, multi-scale risk assessment of the burden of TB attributable to long-term PM2.5, PM2.5-10, and PM10 exposure from 2013 to 2019, employing the multivariate distributed lag nonlinear model (MVDLNM), Lorenz curve and Gini index. Our health impact assessments indicate that PM exposure has resulted in significant increases in TB burden. Specifically, approximately $1,202 million (95% CI: 801-1,573 million), $486 million (95% CI: 398-572 million), and $944 million (95% CI: 767-1,115 million) of health economic costs could be attributed to long-term exposure to PM2.5, PM2.5-10, and PM10, respectively. Although the overall the burden of TB attributable to PM exposure was significantly reduced from 2013 to 2019, regional inequalities have become more pronounced. The Gini index reveals a clear disparity in the burden of TB related to PM exposure across provincial, city, and county levels. These disparities are most pronounced at the county level (0.4914-0.6801), followed by the city level (0.4135-0.6382), and are least evident at the province level (0.3672-0.6078). Overall, the regional inequalities in the burden of TB are more pronounced at finer spatial scales. Our study highlights the health impacts of long-term exposure to PM on the incidence of TB across different spatiotemporal scales, and the findings provide strong scientific evidence for pollution mitigation and efforts to reduce regional inequality.