Journal Article

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

Lin, Y. S., Ma, K., Fang, F. M., Tong, F., Yao, Y. R.

2026

Overview

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. Plain Language Summary Ambient particulate matter (PM) pollution is a significant environmental risk factor contributing to the high tuberculosis (TB) burden in China. Although substantial improvements in air quality have been achieved in recent years, the impact of these improvements on TB incidence remains unclear, and regional exposure inequity has seldom been explored. This study systematically evaluates how regional disparities in health economic costs attributable to long‐term exposure to different sizes of PM (PM2.5, PM2.5–10, and PM10) vary over time and across spatial scales, including the macro‐scale (provincial level), meso‐scale (city level), and micro‐scale (county level). It found that long‐term PM exposure caused billions of dollars in TB‐related health costs, with PM2.5 being the largest contributor. While overall PM‐related TB burden decreased nationwide from 2013 to 2019, inequalities between regions grew, especially at finer scales like counties. Disparities in TB burden were highest at the county level, demonstrating that local conditions strongly influence health risks. This study highlights the urgent need for targeted air quality and health policies in high‐risk areas to reduce TB burden and address health inequalities. Key Points Long‐term exposure to PM2.5–10 was associated with an increased risk of tuberculosis incidence Health economic losses attributable to long‐term particulate matter exposure exceeded one billion USD from 2013 to 2019 Regional inequalities in the tuberculosis burden were more pronounced at finer spatial scales

• Publisher: John Wiley & Sons, Inc,Wiley,American Geophysical Union (AGU)
• Subject: Air pollution / Chronic illnesses / Exposure / Geohealth / health economic burden / Human‐Environment Interactions in GeoHealth: Addressing Terrestrial Ecosystem Health, Land Degradation, and Carbon Management / Humidity / Impacts of Climate Change: Ecosystem Health / inequality / Infectious diseases / multi‐spatial scales / Outdoor air quality / Particulate matter / Pollutants / Pollution control / Population / Provinces / Regions / Risk assessment / Socioeconomic factors / Trends / Tuberculosis