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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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Independent and joint effects of risk factors on self-reported symptoms of active TB disease, 18–54 years in men.
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pone-0096433-g002: Independent and joint effects of risk factors on self-reported symptoms of active TB disease, 18–54 years in men.

Mentions: Drinking and smoking were closely correlated in men; about 38% of the control men (6,288/16,352) without any history of self-reported symptoms of active TB reported both drinking alcohol and smoking tobacco. Among women, reported drinking and smoking was less common (14%; 1,112/8,021; Figure 2). By contrast the other dyads of diabetes, drinking, smoking, and BMI<18·5 kg/m2 were less common in men and women. The floating absolute risks of the six dyads of exposure, comparing independent and interactive relative risks (smoking, drinking, diabetes, and BMI<18·5 kg/m2), were adjusted for age and education (see Figures 2 & 3). In men, the risks of self-reported symptoms of active TB for individual risk factors were statistically significant for those reporting a history of diabetes who did not drink alcohol (RR = 4.5), diabetics who did not smoke tobacco (RR = 3.5), diabetics with BMI> = 18·5 kg/m2 (RR = 2.9; but with large heterogeneity across the countries), and those with BMI<18·5 kg/m2 who did not drink alcohol (RR = 2.5) (Figure 2). In men, the risks from joint exposures were statistically significant diabetics with BMI<18·5 kg/m2 (RR = 6.4), for diabetics who smoked (RR = 4.3, with large heterogeneity across countries), and diabetics who drank alcohol (RR = 3·2). Much lower individual and joint risks were seen for smoking or drinking in men. The numbers of cases in men and women were small for the dyads related to diabetes and BMI<18·5 kg/m2, and the confidence intervals were wide. Similarly, the small number of cases precluded the ability to detect statistically significant interactions of joint exposures.


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)

Independent and joint effects of risk factors on self-reported symptoms of active TB disease, 18–54 years in men.
© Copyright Policy
Related In: Results  -  Collection

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

pone-0096433-g002: Independent and joint effects of risk factors on self-reported symptoms of active TB disease, 18–54 years in men.
Mentions: Drinking and smoking were closely correlated in men; about 38% of the control men (6,288/16,352) without any history of self-reported symptoms of active TB reported both drinking alcohol and smoking tobacco. Among women, reported drinking and smoking was less common (14%; 1,112/8,021; Figure 2). By contrast the other dyads of diabetes, drinking, smoking, and BMI<18·5 kg/m2 were less common in men and women. The floating absolute risks of the six dyads of exposure, comparing independent and interactive relative risks (smoking, drinking, diabetes, and BMI<18·5 kg/m2), were adjusted for age and education (see Figures 2 & 3). In men, the risks of self-reported symptoms of active TB for individual risk factors were statistically significant for those reporting a history of diabetes who did not drink alcohol (RR = 4.5), diabetics who did not smoke tobacco (RR = 3.5), diabetics with BMI> = 18·5 kg/m2 (RR = 2.9; but with large heterogeneity across the countries), and those with BMI<18·5 kg/m2 who did not drink alcohol (RR = 2.5) (Figure 2). In men, the risks from joint exposures were statistically significant diabetics with BMI<18·5 kg/m2 (RR = 6.4), for diabetics who smoked (RR = 4.3, with large heterogeneity across countries), and diabetics who drank alcohol (RR = 3·2). Much lower individual and joint risks were seen for smoking or drinking in men. The numbers of cases in men and women were small for the dyads related to diabetes and BMI<18·5 kg/m2, and the confidence intervals were wide. Similarly, the small number of cases precluded the ability to detect statistically significant interactions of joint exposures.

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