Population transmission dynamic modeling of air pollution-associated tuberculosis endemic in regions of Taiwan and their incidence rate contribution assessment

• Main Authors: Hsing-Chieh Lin, 林幸潔
• Other Authors: Chung-Min Liao
• Format: Others
• Language: zh-TW
• Published: 2018
• Online Access: http://ndltd.ncl.edu.tw/handle/vy9hr3

碩士 === 國立臺灣大學 === 生物環境系統工程學研究所 === 106 === Tuberculosis (TB), known as a serious public health issue, is a notifiable communicable disease with the highest incidence and mortality rate in Taiwan. Recent epidemiological studies demonstrated that exposure to air pollution was positively associated with TB development, leading to pose potentially impacts on TB disease burden and transmission. The objectives of this thesis were to assess the contribution risk of air pollution exposure to TB incidence rate and to evaluate the air pollution-associated TB transmission dynamics. This study developed a probabilistic risk framework to estimate the burden of TB incidence rates attributable to air pollution exposure by incorporating the dose-response relationship between air pollution and population attributable fraction (PAF) under severe and moderate scenarios based on the previous cohort study data. An integrated air pollution-associated TB population transmission dynamic model was constructed to elucidate how air pollution exposure influences the TB transmission dynamics. The dose-response relationship between air pollution concentrations and basic reproduction number (R0) was constructed to provide site-specific air pollution concentration recommendations for controlling TB transmission. Results indicated that, under severe PAF scenario at 50% risk probability, TB incidence was mainly attributable to carbon monoxide (CO) and particulate matter with aerodynamic diameter ≤ 10 μm (PM10) exposure among air pollutants; whereas under moderate scenario, the major air pollutants that contributed to TB incidence were nitrogen oxides (NOX) and nitrogen dioxide (NO2). Taipei City had the highest contribution of air pollution exposure to TB incidence. Model validation results indicated that the integrated transmission dynamic model well-described the trends of monthly TB incidence rates in recent 10 years. The estimated total TB R0s in Taipei City, Hualien, Taitung, and Pingtung Counties were greater than 1, implicating that the TB epidemic is highly likely to spread due partly to air pollution exposure. The results also implicated that air pollution exposure had potential impacts on TB reactivation mechanism. Furthermore, for controlling TB transmission, the proposed recommendations of annual average sulfur dioxide (SO2) concentrations should be lower than 1.69 and 1.61 in Taipei City and Pingtung County, respectively. This thesis assessed the contribution of air pollution to TB incidence based on a probabilistic point of view and provided an integrated air pollution-associated transmission dynamic model to understand the impact of air pollution on TB transmission mechanisms. The proposed air pollution recommendations are help for developing the TB control strategies.