Project title
環境相關危險因子對台灣結核病發生之影響
Internal ID
NSC101-2314-B002-124
Principal Investigator
Start Date
August 1, 2012
End Date
July 12, 2013
Investigators
Organizations
Partner Organizations
Investigating the Impact of Environmental Risk Factors for Tuberculosis in Taiwan---Population-Based Study = 環境相關危險因子對台灣結核病發生之影響
Description
Background: In addition to individual-level risk factors, environmental factors may also play an important role in the incidence of tuberculosis, either through increasing exposure to infectious sources or through impairing the host defense mechanism against the pathogen. Previous study have not addressed two important environmental factors, health care exposure for the patients and ambient air pollution. Environmental risk factors for TB have different implications on TB control compared to individual-level risk factors, as the target of intervention on environmental risk factors would be the administrative level, such as the national policy on air pollution or hospital policy on infection control. Objectives: Using the individual-level data from the 2000 Longitudinal Health Insurance Database (LHID) of Taiwan, we propose to characterize two environmental risk factors for TB in Taiwan with the following aims: 1) To validate the accuracy of using health insurance claims data to identify cases of TB in Taiwan; 2) To investigate the association between health care visit and incident TB disease in Taiwan; 3) To investigate the association between chronic exposure to ambient air pollution and incident TB. Methods: In the first aim of the project, we will validate the accuracy of several case definitions of TB based on ICD-9 and prescription record in the health insurance information among the 2001 National Health Interview Survey participants. TB notification to Taiwan CDC will be used as the gold standard. In the second aim, we will use the cohort of individuals in the 2000 LHID to study the association between intensity of outpatient and inpatient visit and subsequent development of TB. The potential influence of unmeasured confounding by variables not included in the LHID will be explored with bias analysis and propensity score calibration using external information from the 2001 National Health Interview Survey. In the third aim we will use the air pollution estimates from Taiwan Air Quality Monitoring Network and the 2000 LHID to study ambient air pollution as a risk factor for TB, adjusting for individual-level and area-level confounders. We will conduct subgroup analysis to identify subgroups of individuals who are most vulnerable to the effect of air pollution. Anticipated results: Our validation study will provide information on the accuracy of different case definitions using health insurance database and will be valuable for future TB studies that utilize national health insurance database. The study on health care visit as a risk factor for TB will inform policy makers and infection control personnel on potential ways of interventions, such as improving ventilation, environmental disinfection, patient flow logistics in outpatient clinics, and health education for the general population. The study on ambient air pollution and incidence of TB will be the first epidemiological study in the world on this association. As air pollution is highly prevalent in many high TB burden countries, the results will critically inform global TB control policies that consider risk factor intervention as part of the strategies to eliminate TB.