Smoking Increases Risk for Tuberculosis

A new study has found that tobacco smoking is associated with a two-fold increased risk for active tuberculosis (TB).

Researchers from the Harvard School of Public Health (HSPH; Boston, MA, USA) conducted a prospective cohort study involving 17,699 people over 12 years of age that participated in the Taiwan National Health Interview Survey, and that were followed-up from 2001 to 2004. Smoking status and other covariates were measured by a personal interview at baseline; incident cases of active TB were identified from the Taiwanese national health insurance database. Multivariate logistic regression was used to estimate the association between smoking status and active TB, with adjustment for age, sex, alcohol consumption, socioeconomic status, and other covariates.

The researchers found that 57 new cases of active TB occurred during the 3.3 years of follow-up. Current smoking was associated with an increased risk of active tuberculosis, and the association was stronger among those less than 65 years of age than in those above 65 years. Significant dose-response relations were found for cigarettes per day, years of smoking, and pack-years. Limitations of the study included deaths not recorded in the database, short duration of follow-up, and lack of data from bacteriologic studies for the diagnosis of TB. The study was published in the September 1, 2009, issue of the American Journal of Respiratory and Critical Care Medicine.

"The finding that smoking increases the risk of tuberculosis suggests that tobacco control be considered as an important component in the global effort to eliminate tuberculosis,” concluded lead author Hsien-Ho Lin, M.D., Sc.D., and colleagues from the from the HSPH. "Policy makers and public health personnel should consider addressing tobacco cessation as part of tuberculosis control.”

Recent studies suggest that introducing brief tobacco cessation advice may be feasible among TB patients, and an integrated approach has been proposed to monitor smoking cessation in TB care. From the perspective of prevention, the authors recommend that the target of smoking cessation should aim beyond TB patients, to reach high-risk populations who are likely to benefit most from cessation.

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