A case-control study of household air pollution and tuberculosis in women and young children in urban India
Embargo until
2020-05-01
Date
2016-01-12
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Johns Hopkins University
Abstract
Background: Household air pollution (HAP) is a known risk factor for many respiratory diseases, however the association between HAP and tuberculosis (TB) is still inconclusive. The purpose of this study is to characterize exposure to common sources of HAP in low-income urban Indian households and estimate the association between HAP and TB.
Methods: A matched case-control study was conducted among adult women and children. Index cases were recruited from TB control program clinics, and controls were healthy individuals matched on geography, age, and sex. Particulate matter less than 2.5 microns (PM2.5) and carbon monoxide (CO) concentrations were measured in each household and compared across case and control participants. Household use of cooking and heating fuels, as well as reported exposure to other sources of HAP was collected. Exposure to secondhand tobacco smoke (SHS) was measured through household air nicotine concentration and participant hair nicotine concentration.
Results: A total of 127 households were enrolled, 8 of which were excluded due to incomplete household exposure data. In the case-control analysis, 118 individuals with complete case-control pairs were included. Kerosene was used by 26 (22%) of households, and 32 (27%) of households reported using wood as a primary or secondary fuel source. The median 24-hour mean concentration of PM2.5 in households was 184 μg/m3 (IQR: 113-347), well above the recommended 24-hour guideline of 25 μg/m3. Odds of TB was marginally statistically significantly associated with higher levels of PM2.5 (OR 3.30, 95% CI: 0.95 - 11.51). Those in the upper quartile of exposure were more likely to use wood (OR 5.53; 95% CI: 1.62 - 20.39) and mosquito coils (OR 3.82; 95% CI: 1.31 - 11.79). Reported measures of exposure to SHS were not valid in this population, weakly identifying those with detectable air (n=31, 32%) and hair (n=42, 68%) nicotine.
Discussion: Households in low-income urban communities are highly exposed to HAP from cooking fuels, SHS, and other pollutant sources. High levels of HAP exposure tend to be associated with TB, raising concern for implications at the population level in countries with dual burden of both HAP and TB.
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Keywords
household air pollution, tobacco, tuberculosis