Investigation of Indoor Solid Fuel and Kerosene Use as Tuberculosis Risk Factors

室内固体燃料和煤油使用作为结核病危险因素的调查

基本信息

批准号：
8826119
负责人：
MICHAEL N BATES
金额：
$ 57.91万
依托单位：
UNIVERSITY OF CALIFORNIA BERKELEY
依托单位国家：
美国
项目类别：
财政年份：
2011
资助国家：
美国
起止时间：
2011-08-16 至 2017-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8826119
关键词：
AIDS/HIV problem Affect Agriculture Air Alcohol consumption Area Asia Biological Assay Biomass Budgets Burn injury Case-Control Studies Cattle Communicable Diseases Complex Cost-Benefit Analysis Country Crowding Data Data Analyses Developed Countries Developing Countries Development Disease Drug resistance in tuberculosis Environmental air flow Exposure to Extreme drug resistant tuberculosis Family history of Fossil Fuels Frequencies Government HIV Infections Health Policy Heating Home heating Hospitals Household Housing Immigration Immune system Impairment Indoor Air Pollution Infection Interferons International International Agencies Intervention Investigation Kerosene Life Lighting Lung diseases Malnutrition Measurement Methodology Modeling Mycobacterium tuberculosis Nepal Newly Diagnosed Odds Ratio Participant Particulate Matter Petroleum Policies Population Predisposition Prevalence Questionnaires Recruitment Activity Relative Risks Risk Risk Factors Selection Bias Smoke T-Lymphocyte Testing Time Tobacco smoking Tobacco use Travel Tuberculin Test Tuberculosis Wood material Work base biomass fuel biomass smoke combustion product cooking disorder risk indoor exposure interest latent infection modifiable risk mortality policy implication solid fuel systematic review wasting

项目摘要

DESCRIPTION (provided by applicant): Among infectious diseases, tuberculosis (TB) is second only to HIV/AIDS in causing mortality. About one-third of the world's population have TB infection. Most infected people never develop active TB, but form a reservoir of latent infections that can progress to become active disease. Therefore, modifiable risk factors for TB infection or for progress from infection to active TB need to be identified. The most common fuel for heating and cooking in developing countries is biomass (wood, cow dung and agricultural waste), often burnt without any chimney or ventilation. Houses fill with smoke. Whether biomass smoke increases TB risk is uncertain. Our previous work, a TB case-control study in Nepal, found indoor biomass burning as a heating fuel, and use of kerosene, for cooking or lighting, to be likely strong risk factors for TB disease. Whether kerosene use is a TB risk factor has not been investigated before. However, there is the possibility that selection bias was responsible for our results. Therefore, we propose a further case-control study of TB using a more rigorous control selection methodology, while collecting more extensive exposure data for indoor fuel use. We will also identify the controls with latent TB infection, using T-cell-based interferon-3 release assays and use the latent TB-positive controls in a separate set of data analyses. Over 3.25 years, we will recruit 650 newly diagnosed TB cases from the Pokhara Regional TB Center, Nepal, and 1300 frequency-matched controls selected from the village areas in which the cases live. Each participant will be administered a questionnaire on fuel use for cooking, heating and lighting, as well as seeking information on other potential TB risk factors. All the controls will be tested for latent TB infection. Measurements of air exchange rates (AER) and CO and particulate matter emissions will be obtained from nearly one-quarter of the study households (n=450). We will use the measurement data to model AERs and emission levels in the households where actual measurements are not made. In addition to the data analyses using all controls, we will carry out a parallel set of analyses using only the controls who are positive for TB infection. Division of the odds ratio (OR) obtained using all controls by the corresponding OR obtained using just latently infected controls will provide an estimate of the relative risk for TB infection. Data analysis will focus on identifying whether kerosene or biomass, as heating, lighting or cooking fuels, are risk factors for TB disease or infection. Findings showing either biomass or kerosene fuel to be risk factors, will have major implications for health policy and interventions. If kerosene is a risk factor, then this will provide justification for not treating it as a clean fuel alternative to biomass, as is currently the policy of some international agencies.

描述（由申请人提供）：在传染病中，结核病（TB）仅次于艾滋病毒/艾滋病引起死亡。世界上约有三分之一的人口感染结核病。大多数感染者从不发展活跃的结核病，而是形成潜在感染的储层，可以发展成为活跃疾病。因此，需要确定结核病感染或从感染到主动结核的进展的可修改风险因素。发展中国家加热和烹饪的最常见燃料是生物质（木材，牛粪和农业废物），通常不会燃烧而没有任何烟囱或通风。房屋充满了烟。生物量烟雾是否会增加结核病风险是不确定的。我们以前的工作是尼泊尔的TB病例对照研究，发现室内生物质燃烧是一种加热燃料，并使用煤油在烹饪或照明中使用，可能是结核病疾病的强大风险因素。煤油使用是否为结核病风险因素，以前尚未研究过。但是，有可能选择偏见是我们的结果。因此，我们建议使用更严格的控制选择方法对结核病进行进一步的病例对照研究，同时收集更广泛的暴露数据以供室内燃料使用。我们还将使用基于T细胞的Interferon-3释放测定法确定具有潜在结核病感染的控制，并在单独的一组数据分析中使用潜在的TB阳性控件。在3。25年的时间里，我们将从尼泊尔Pokhara地区结核病中心招募650例新诊断的结核病病例，并从案件居住的村庄区域中选出的1300个频率匹配的控件。每个参与者将接受有关烹饪，供暖和照明燃料使用的问卷调查，并寻求有关其他潜在结核病风险因素的信息。所有控件将测试潜在结核病感染。空气汇率（AER）和CO和颗粒物排放的测量将从研究家庭的近四分之一（n = 450）获得。我们将使用测量数据对未进行实际测量的家庭中的AER和排放水平进行建模。除了使用所有控件的数据分析外，我们还将仅使用对结核病感染阳性的控件进行一组平行的分析。使用所有对应的控制或仅使用潜在感染对照获得的所有控件获得的优势比（OR）的划分将提供对结核病感染的相对风险的估计。数据分析将集中于确定煤油或生物量（作为加热，照明或烹饪燃料）是结核病疾病或感染的危险因素。结果表明生物质或煤油燃料是危险因素，将对卫生政策和干预措施产生重大影响。如果煤油是危险因素，那么这将为不将其视为生物质的清洁燃料替代品提供理由，就像目前一些国际机构的政策一样。