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Tobacco smoking, alcohol drinking, diabetes, low body mass index and the risk of self-reported symptoms of active tuberculosis: individual participant data (IPD) meta-analyses of 72,684 individuals in 14 high tuberculosis burden countries.

Patra J, Jha P, Rehm J, Suraweera W - PLoS ONE (2014)

Bottom Line: The effects of multiple exposures on active tuberculosis (TB) are largely undetermined.In men, the risks from joint exposures were statistically significant for diabetics with BMI<18.5 kg/m2 (RR = 6.4), diabetics who smoked (RR = 3.8), and diabetics who drank alcohol (RR = 3.2).The risks from joint risk factors were generally larger in women than in men, with statistically significant risks for diabetics with BMI<18.5 kg/m2 (RR = 10.0), diabetics who smoked (RR = 5.4) and women with BMI<18.5 kg/m2 who smoked (RR = 5.0).

View Article: PubMed Central - PubMed

Affiliation: Centre for Global Health Research, St Michael's Hospital, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.

ABSTRACT

Background: The effects of multiple exposures on active tuberculosis (TB) are largely undetermined. We sought to establish a dose-response relationship for smoking, drinking, and body mass index (BMI) and to investigate the independent and joint effects of these and diabetes on the risk of self-reported symptoms of active TB disease.

Methods and findings: We analyzed 14 national studies in 14 high TB-burden countries using self-reports of blood in cough/phlegm and cough lasting > = 3 weeks in the last year as the measures of symptoms of active TB. The random effect estimates of the relative risks (RR) between active TB and smoking, drinking, diabetes, and BMI<18.5 kg/m2 were reported for each gender. Floating absolute risks were used to examine dyads of exposure. Adjusted for age and education, the risks of active TB were significantly associated with diabetes and BMI<18.5 kg/m2 in both sexes, with ever drinking in men and with ever smoking in women. Stronger dose-response relationships were seen in women than in men for smoking amount, smoking duration and drinking amount but BMI<18.5 kg/m2 showed a stronger dose-response relationship in men. In men, the risks from joint exposures were statistically significant for diabetics with BMI<18.5 kg/m2 (RR = 6.4), diabetics who smoked (RR = 3.8), and diabetics who drank alcohol (RR = 3.2). The risks from joint risk factors were generally larger in women than in men, with statistically significant risks for diabetics with BMI<18.5 kg/m2 (RR = 10.0), diabetics who smoked (RR = 5.4) and women with BMI<18.5 kg/m2 who smoked (RR = 5.0). These risk factors account for 61% of male and 34% of female estimated TB incidents in these 14 countries.

Conclusions: Tobacco, alcohol, diabetes, and low BMI are significant individual risk factors but in combination are associated with triple or quadruple the risk of development of recent active TB. These risk factors might help to explain the wide variation in TB across countries.

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Related in: MedlinePlus

Dose-response relationships of (A) duration of smoking, (B) quantity of smoking, (C) quantity of alcohol consumption, and (D) BMI with self-reported symptoms of active TB disease by gender.
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pone-0096433-g001: Dose-response relationships of (A) duration of smoking, (B) quantity of smoking, (C) quantity of alcohol consumption, and (D) BMI with self-reported symptoms of active TB disease by gender.

Mentions: After adjustment for confounders, smoking amount, smoking duration and drinking amount showed a stronger dose response relationship in women than in men; however BMI<18·5 kg/m2 showed a stronger dose-response relationship in men (Table 3). Substantial risks of self-reported symptoms of active TB were seen in men and especially in women for 21 or more years of smoking (Men RR = 1·6; Women RR = 2·0), 21 or more cigarettes per day (Men RR = 2·2, Women RR = 3·0), for 3 or more standard drinks (Men RR = 1·3, Women RR = 3.2) and for BMI<16·0 kg/m2 (Men RR = 3.5, Women RR = 2.7). Use of linear units to measure smoking and alcohol quantity showed similar findings to the categorical results with a weaker association for the duration of smoking. Smoking amount, smoking duration, and drinking amount showed a steeper dose-response relationships in women than in men (Figure 1). By contrast, BMI<17·0 kg/m2 showed similar yet stronger (RR>2·1) relationships in both men and women. The heterogeneity of the risks across countries was below 20%, with the exception of number of cigarettes per day and number of standard drinks in both men and women.


Tobacco smoking, alcohol drinking, diabetes, low body mass index and the risk of self-reported symptoms of active tuberculosis: individual participant data (IPD) meta-analyses of 72,684 individuals in 14 high tuberculosis burden countries.

Patra J, Jha P, Rehm J, Suraweera W - PLoS ONE (2014)

Dose-response relationships of (A) duration of smoking, (B) quantity of smoking, (C) quantity of alcohol consumption, and (D) BMI with self-reported symptoms of active TB disease by gender.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4008623&req=5

pone-0096433-g001: Dose-response relationships of (A) duration of smoking, (B) quantity of smoking, (C) quantity of alcohol consumption, and (D) BMI with self-reported symptoms of active TB disease by gender.
Mentions: After adjustment for confounders, smoking amount, smoking duration and drinking amount showed a stronger dose response relationship in women than in men; however BMI<18·5 kg/m2 showed a stronger dose-response relationship in men (Table 3). Substantial risks of self-reported symptoms of active TB were seen in men and especially in women for 21 or more years of smoking (Men RR = 1·6; Women RR = 2·0), 21 or more cigarettes per day (Men RR = 2·2, Women RR = 3·0), for 3 or more standard drinks (Men RR = 1·3, Women RR = 3.2) and for BMI<16·0 kg/m2 (Men RR = 3.5, Women RR = 2.7). Use of linear units to measure smoking and alcohol quantity showed similar findings to the categorical results with a weaker association for the duration of smoking. Smoking amount, smoking duration, and drinking amount showed a steeper dose-response relationships in women than in men (Figure 1). By contrast, BMI<17·0 kg/m2 showed similar yet stronger (RR>2·1) relationships in both men and women. The heterogeneity of the risks across countries was below 20%, with the exception of number of cigarettes per day and number of standard drinks in both men and women.

Bottom Line: The effects of multiple exposures on active tuberculosis (TB) are largely undetermined.In men, the risks from joint exposures were statistically significant for diabetics with BMI<18.5 kg/m2 (RR = 6.4), diabetics who smoked (RR = 3.8), and diabetics who drank alcohol (RR = 3.2).The risks from joint risk factors were generally larger in women than in men, with statistically significant risks for diabetics with BMI<18.5 kg/m2 (RR = 10.0), diabetics who smoked (RR = 5.4) and women with BMI<18.5 kg/m2 who smoked (RR = 5.0).

View Article: PubMed Central - PubMed

Affiliation: Centre for Global Health Research, St Michael's Hospital, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.

ABSTRACT

Background: The effects of multiple exposures on active tuberculosis (TB) are largely undetermined. We sought to establish a dose-response relationship for smoking, drinking, and body mass index (BMI) and to investigate the independent and joint effects of these and diabetes on the risk of self-reported symptoms of active TB disease.

Methods and findings: We analyzed 14 national studies in 14 high TB-burden countries using self-reports of blood in cough/phlegm and cough lasting > = 3 weeks in the last year as the measures of symptoms of active TB. The random effect estimates of the relative risks (RR) between active TB and smoking, drinking, diabetes, and BMI<18.5 kg/m2 were reported for each gender. Floating absolute risks were used to examine dyads of exposure. Adjusted for age and education, the risks of active TB were significantly associated with diabetes and BMI<18.5 kg/m2 in both sexes, with ever drinking in men and with ever smoking in women. Stronger dose-response relationships were seen in women than in men for smoking amount, smoking duration and drinking amount but BMI<18.5 kg/m2 showed a stronger dose-response relationship in men. In men, the risks from joint exposures were statistically significant for diabetics with BMI<18.5 kg/m2 (RR = 6.4), diabetics who smoked (RR = 3.8), and diabetics who drank alcohol (RR = 3.2). The risks from joint risk factors were generally larger in women than in men, with statistically significant risks for diabetics with BMI<18.5 kg/m2 (RR = 10.0), diabetics who smoked (RR = 5.4) and women with BMI<18.5 kg/m2 who smoked (RR = 5.0). These risk factors account for 61% of male and 34% of female estimated TB incidents in these 14 countries.

Conclusions: Tobacco, alcohol, diabetes, and low BMI are significant individual risk factors but in combination are associated with triple or quadruple the risk of development of recent active TB. These risk factors might help to explain the wide variation in TB across countries.

Show MeSH
Related in: MedlinePlus