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Alcohol use as a risk factor for tuberculosis - a systematic review.

Lönnroth K, Williams BG, Stadlin S, Jaramillo E, Dye C - BMC Public Health (2008)

Bottom Line: Pooled effect sizes were obtained for each sub-category of studies.Subgroup analyses of studies that had controlled for various sets of confounders did not give significantly different results and did not explain the significant heterogeneity that was found across the studies.This may be due to both increased risk of infection related to specific social mixing patterns associated with alcohol use, as well as influence on the immune system of alcohol itself and of alcohol related conditions.

View Article: PubMed Central - HTML - PubMed

Affiliation: Stop TB Department, World Health Organization, Geneva, Switzerland. lonnrothk@who.int

ABSTRACT

Background: It has long been evident that there is an association between alcohol use and risk of tuberculosis. It has not been established to what extent this association is confounded by social and other factors related to alcohol use. Nor has the strength of the association been established. The objective of this study was to systematically review the available evidence on the association between alcohol use and the risk of tuberculosis.

Methods: Based on a systematic literature review, we identified 3 cohort and 18 case control studies. These were further categorized according to definition of exposure, type of tuberculosis used as study outcome, and confounders controlled for. Pooled effect sizes were obtained for each sub-category of studies.

Results: The pooled relative risk across all studies that used an exposure cut-off level set at 40 g alcohol per day or above, or defined exposure as a clinical diagnosis of an alcohol use disorder, was 3.50 (95% CI: 2.01-5.93). After exclusion of small studies, because of suspected publication bias, the pooled relative risk was 2.94 (95% CI: 1.89-4.59). Subgroup analyses of studies that had controlled for various sets of confounders did not give significantly different results and did not explain the significant heterogeneity that was found across the studies.

Conclusion: The risk of active tuberculosis is substantially elevated in people who drink more than 40 g alcohol per day, and/or have an alcohol use disorder. This may be due to both increased risk of infection related to specific social mixing patterns associated with alcohol use, as well as influence on the immune system of alcohol itself and of alcohol related conditions.

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Related in: MedlinePlus

Funnel plot of the odds-ratio against the precision of the estimates. Points to the right of the dashed line are significant at the 5% level. The apex of the funnel gives the point estimate. Points outside the funnel differ from the point estimate at the 5% level and suggest heterogeneity in the estimates. If there is no bias in the selection of studies for publication, the points should be evenly scattered to the left and right. Squares represent the three studies with largest standard error that were excluded in the category "Excluding three smallest studies" in table 2 (Mori et al 1992, Spletter 2000, and Riekstina et al 2005). The two filled circles that are outside the funnel represent the two additional studies that were excluded in the category "Excluding three smallest and Brown I and Kim" in table 2
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Figure 2: Funnel plot of the odds-ratio against the precision of the estimates. Points to the right of the dashed line are significant at the 5% level. The apex of the funnel gives the point estimate. Points outside the funnel differ from the point estimate at the 5% level and suggest heterogeneity in the estimates. If there is no bias in the selection of studies for publication, the points should be evenly scattered to the left and right. Squares represent the three studies with largest standard error that were excluded in the category "Excluding three smallest studies" in table 2 (Mori et al 1992, Spletter 2000, and Riekstina et al 2005). The two filled circles that are outside the funnel represent the two additional studies that were excluded in the category "Excluding three smallest and Brown I and Kim" in table 2

Mentions: Funnel plots indicated that there was under-representation of small studies with weak or absent association, both for all studies combined, as well as for the studies in the high-exposure category (figure 2).


Alcohol use as a risk factor for tuberculosis - a systematic review.

Lönnroth K, Williams BG, Stadlin S, Jaramillo E, Dye C - BMC Public Health (2008)

Funnel plot of the odds-ratio against the precision of the estimates. Points to the right of the dashed line are significant at the 5% level. The apex of the funnel gives the point estimate. Points outside the funnel differ from the point estimate at the 5% level and suggest heterogeneity in the estimates. If there is no bias in the selection of studies for publication, the points should be evenly scattered to the left and right. Squares represent the three studies with largest standard error that were excluded in the category "Excluding three smallest studies" in table 2 (Mori et al 1992, Spletter 2000, and Riekstina et al 2005). The two filled circles that are outside the funnel represent the two additional studies that were excluded in the category "Excluding three smallest and Brown I and Kim" in table 2
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2533327&req=5

Figure 2: Funnel plot of the odds-ratio against the precision of the estimates. Points to the right of the dashed line are significant at the 5% level. The apex of the funnel gives the point estimate. Points outside the funnel differ from the point estimate at the 5% level and suggest heterogeneity in the estimates. If there is no bias in the selection of studies for publication, the points should be evenly scattered to the left and right. Squares represent the three studies with largest standard error that were excluded in the category "Excluding three smallest studies" in table 2 (Mori et al 1992, Spletter 2000, and Riekstina et al 2005). The two filled circles that are outside the funnel represent the two additional studies that were excluded in the category "Excluding three smallest and Brown I and Kim" in table 2
Mentions: Funnel plots indicated that there was under-representation of small studies with weak or absent association, both for all studies combined, as well as for the studies in the high-exposure category (figure 2).

Bottom Line: Pooled effect sizes were obtained for each sub-category of studies.Subgroup analyses of studies that had controlled for various sets of confounders did not give significantly different results and did not explain the significant heterogeneity that was found across the studies.This may be due to both increased risk of infection related to specific social mixing patterns associated with alcohol use, as well as influence on the immune system of alcohol itself and of alcohol related conditions.

View Article: PubMed Central - HTML - PubMed

Affiliation: Stop TB Department, World Health Organization, Geneva, Switzerland. lonnrothk@who.int

ABSTRACT

Background: It has long been evident that there is an association between alcohol use and risk of tuberculosis. It has not been established to what extent this association is confounded by social and other factors related to alcohol use. Nor has the strength of the association been established. The objective of this study was to systematically review the available evidence on the association between alcohol use and the risk of tuberculosis.

Methods: Based on a systematic literature review, we identified 3 cohort and 18 case control studies. These were further categorized according to definition of exposure, type of tuberculosis used as study outcome, and confounders controlled for. Pooled effect sizes were obtained for each sub-category of studies.

Results: The pooled relative risk across all studies that used an exposure cut-off level set at 40 g alcohol per day or above, or defined exposure as a clinical diagnosis of an alcohol use disorder, was 3.50 (95% CI: 2.01-5.93). After exclusion of small studies, because of suspected publication bias, the pooled relative risk was 2.94 (95% CI: 1.89-4.59). Subgroup analyses of studies that had controlled for various sets of confounders did not give significantly different results and did not explain the significant heterogeneity that was found across the studies.

Conclusion: The risk of active tuberculosis is substantially elevated in people who drink more than 40 g alcohol per day, and/or have an alcohol use disorder. This may be due to both increased risk of infection related to specific social mixing patterns associated with alcohol use, as well as influence on the immune system of alcohol itself and of alcohol related conditions.

Show MeSH
Related in: MedlinePlus