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Odeny L, Gathecha G, Mwenda V, Kendagor A, Cheburet S, Mugi B, Mithi C, Jaguga F, Okinda K, Devotsu RK, Mohamed SF, Ong’ang’o JR. Tobacco smoking-attributable mortality in Kenya, 2012-2021. Tob Induc Dis 2024; 22:TID-22-134. [PMID: 39050115 PMCID: PMC11267916 DOI: 10.18332/tid/186170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 04/10/2023] [Accepted: 03/16/2024] [Indexed: 07/27/2024] Open
Abstract
INTRODUCTION Tobacco smoking poses a significant risk for various diseases, including cardiovascular diseases, chronic respiratory diseases, and cancers. In Kenya, tobacco-related deaths contribute substantially to non-communicable disease mortality. This study aims to quantify the mortality attributed to tobacco smoking in Kenya from 2012 to 2021. METHODS Employing a prevalence-based analysis model, the study utilized population attributable fraction (PAF) to estimate age-specific smoke attributable mortality (SAM) rates for individuals aged ≥35 years. Causes of death associated with tobacco use, including cancers, cardiovascular diseases, respiratory diseases, tuberculosis, and diabetes, were analyzed based on age, sex, and death records between 2012 and 2021. RESULTS Over the study period, 60228 deaths were attributed to tobacco-related diseases, with an annual increase observed until 2016 and subsequent fluctuations. Respiratory diseases, diabetes mellitus, malignant cancers, tuberculosis, and cardiovascular diseases collectively accounted for 16.5% of deaths among individuals aged ≥35 years. Notable contributors were pneumonia and influenza (respiratory diseases), esophageal cancer (cancers), and cerebrovascular diseases (cardiovascular diseases). Of the observed deaths, 16.5% were attributed to smoking, with respiratory diseases (40.5%), malignant cancers (31.4%), tuberculosis (13%), cardiovascular diseases (8.9%), and diabetes mellitus (6.1%) contributing. Pneumonia and influenza, esophageal cancer, chronic airway obstruction, and tuberculosis were primary causes, comprising 70% of all SAM. CONCLUSIONS Tobacco-related mortality is a significant public health concern in Kenya. Efforts should focus on preventing tobacco use and managing associated disease burdens. Smoking cessation initiatives and comprehensive tobacco control measures are imperative to mitigate the impact on population health.
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Affiliation(s)
- Lazarus Odeny
- Centre for Respiratory Diseases Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Gladwell Gathecha
- Division of Non-communicable Diseases, Kenya Ministry of Health, Nairobi, Kenya
| | - Valerian Mwenda
- Division of Non-communicable Diseases, Kenya Ministry of Health, Nairobi, Kenya
| | - Anne Kendagor
- Division of Non-communicable Diseases, Kenya Ministry of Health, Nairobi, Kenya
| | - Samuel Cheburet
- Division of Non-communicable Diseases, Kenya Ministry of Health, Nairobi, Kenya
| | - Beatrice Mugi
- Radiology Department, Kenyatta National Hospital, Nairobi, Kenya
| | - Caroline Mithi
- Internal Medicine Department, Kenyatta University Teaching, Referral and Research Hospital, Nairobi, Kenya
| | - Florence Jaguga
- Alcohol and Drug Abuse Rehabilitation Services Department, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Kennedy Okinda
- Research and Program Department, Kenyatta National Hospital, Othaya, Kenya
| | | | - Shukri F. Mohamed
- Chronic Disease Management Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Jane Rahedi Ong’ang’o
- Centre for Respiratory Diseases Research, Kenya Medical Research Institute, Kisumu, Kenya
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Ohkado A, Querri A, Bermejo J, Bartolome R, Pardilla G, Manese D, Recidoro J, Kawatsu L, Garfin AMC, Bam TS. Effectiveness of smoking cessation intervention based on the ABC Approach in patients with TB. Public Health Action 2024; 14:45-50. [PMID: 38957504 PMCID: PMC11216290 DOI: 10.5588/pha.23.0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/14/2024] [Indexed: 07/04/2024] Open
Abstract
SETTING Urban setting in the Philippines. OBJECTIVE To assess the effectiveness of the ABC Approach developed by The Union as a tobacco-smoking cessation intervention for TB patients at a primary healthcare level in an urban setting in the Philippines. DESIGN We set up an intervention group whose patients with TB received the ABC approach and a control group of patients with TB receiving only routine health education in Manila, The Philippines. We collected smoking status and the domestic secondhand-smoking (SHS) status data from patients with TB at months 0, 2, 4, 6, 8, and 12. TB treatment outcome data were also collected. RESULTS Patients with TB (n = 2,174) were enrolled upon TB registration. Smoking rates were consistently low in the intervention group (3.9% vs. 8.7% at Month 6). The odds ratios of both tobacco-smoking status and domestic SHS status in the intervention group were significantly lower than those in the control group (tobacco-smoking status: P < 0.001, domestic SHS status: P < 0.01). TB treatment success rates were similar between the groups (85.0% vs. 87.3%; P = 0.201). CONCLUSION The ABC approach successfully reduced tobacco-smoking rates, maintained low domestic SHS rates and TB treatment success rates in the Philippines.
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Affiliation(s)
- A Ohkado
- Department of Epidemiology and Clinical Research, Research Institute of Tuberculosis (RIT), Japan Anti-Tuberculosis Association (JATA), Kiyose, Japan
| | - A Querri
- Department of Epidemiology and Clinical Research, Research Institute of Tuberculosis (RIT), Japan Anti-Tuberculosis Association (JATA), Kiyose, Japan
| | - J Bermejo
- Manila Health Department (MHD), Manila, The Philippines
| | - R Bartolome
- Manila Health Department (MHD), Manila, The Philippines
| | - G Pardilla
- Manila Health Department (MHD), Manila, The Philippines
| | - D Manese
- Manila Health Department (MHD), Manila, The Philippines
| | - J Recidoro
- Manila Health Department (MHD), Manila, The Philippines
| | - L Kawatsu
- School of Nursing, Nagoya City University, Nagoya, Japan
| | - A M C Garfin
- Department of Health, Disease Prevention and Control Bureau (DOH-DPCB), Manila, The Philippines
| | - T S Bam
- The UNION Asia Pacific Office, Singapore
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Vidyasagaran AL, Readshaw A, Boeckmann M, Jarde A, Siddiqui F, Marshall AM, Akram J, Golub JE, Siddiqi K, Dogar O. Is Tobacco Use Associated With Risk of Recurrence and Mortality Among People With TB?: A Systematic Review and Meta-Analysis. Chest 2024; 165:22-47. [PMID: 37652295 PMCID: PMC10790178 DOI: 10.1016/j.chest.2023.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 06/20/2023] [Accepted: 08/23/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Associations between tobacco use and poor TB treatment outcomes are well documented. However, for important outcomes such as TB recurrence or relapse and mortality during treatment, as well as for associations with smokeless tobacco (ST), the evidence is not summarized systematically. RESEARCH QUESTION Is tobacco use associated with risk of poor treatment outcomes among people with TB? STUDY DESIGN AND METHODS The MEDLINE, Embase, and Cumulative Index of Nursing and Allied Health Literature databases were searched on November 22, 2021. Epidemiologic studies reporting associations between tobacco use and at least one TB treatment outcome were eligible. Independent double-screening, extractions, and quality assessments were undertaken. Random effects meta-analyses were conducted for the two primary review outcomes (TB recurrence or relapse and mortality during treatment), and heterogeneity was explored using subgroups. Other outcomes were synthesized narratively. RESULTS Our searches identified 1,249 records, of which 28 were included in the meta-analyses. Based on 15 studies, higher risk of TB recurrence or relapse was found with ever using tobacco vs never using tobacco (risk ratio [RR], 1.78; 95% CI, 1.31-2.43; I2 = 85%), current tobacco use vs no tobacco use (RR, 1.95; 95% CI, 1.59-2.40; I2 = 72%), and former tobacco use vs never using tobacco (RR, 1.84; 95% CI, 1.21-2.80; I2 = 4%); heterogeneity arose from differences in study quality, design, and participant characteristics. Thirty-eight studies were identified for mortality, of which 13 reported mortality during treatment. Ever tobacco use (RR, 1.55; 95% CI, 1.32-1.81; I2 = 0%) and current tobacco use (RR, 1.51; 95% CI, 1.09-2.10; I2 = 87%) significantly increased the likelihood of mortality during treatment among people with TB compared with never using tobacco and not currently using tobacco, respectively; heterogeneity was explained largely by differences in study design. Almost all studies in the meta-analyses scored high or moderate on quality assessments. Narrative synthesis showed that tobacco use was a risk factor for other unfavorable TB treatment outcomes, as previously documented. Evidence on ST was limited, but identified studies suggested an increased risk for poor outcomes with its use compared with not using it. INTERPRETATION Tobacco use significantly increases the risk of TB recurrence or relapse and mortality during treatment among people with TB, highlighting the need to address tobacco use to improve TB outcomes. TRIAL REGISTRY PROSPERO; No.: CRD42017060821; URL: https://www.crd.york.ac.uk/prospero/.
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Affiliation(s)
| | - Anne Readshaw
- Department of Health Sciences, University of York, York, England; Yorkshire and North Lincolnshire Area Team, Natural England
| | - Melanie Boeckmann
- Department of Global Health, Institute of Public Health and Nursing Research (IPP), University of Bremen, Bremen, Germany
| | - Alexander Jarde
- Université de Paris, Centre d'Épidémiologie Clinique, Hôpital Hôtel-Dieu, and Cochrane France, Paris, France
| | - Faraz Siddiqui
- Department of Health Sciences, University of York, York, England
| | - Anna-Marie Marshall
- Department of Health Sciences, University of York, York, England; Research Fellow in Public Health and lecturer in Public Health and Psychology, Helen McArdle Nursing and Care Research Institute, Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, England
| | - Janita Akram
- Hull York Medical School, University of York, York, England
| | - Jonathan E Golub
- Center for Tuberculosis Research, School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, York, England; Hull York Medical School, University of York, York, England
| | - Omara Dogar
- Department of Health Sciences, University of York, York, England; Usher Institute, The University of Edinburgh, Edinburgh, Scotland.
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Pourali F, Khademloo M, Abedi S, Roozbeh F, Barzegari S, Moosazadeh M. Relationship between smoking and tuberculosis recurrence: A systematic review and meta-analysis. Indian J Tuberc 2023; 70:475-482. [PMID: 37968054 DOI: 10.1016/j.ijtb.2023.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 04/02/2023] [Accepted: 04/10/2023] [Indexed: 11/17/2023]
Abstract
INTRODUCTION Of the problems in tuberculosis (TB) control program is the recurrence of this disease. In some studies, smoking has been reported as the most important risk factor. Therefore, the present study aimed at examining the association between smoking and tuberculosis recurrence using meta-analysis. METHODS To report the findings of this meta-analysis, we used PRISMA. The protocol of this study has been recorded in PROSPERO. The research question has been formulated based on PICO, and the search was performed using both MeSH and non-MeSH keywords. After screening and selecting the articles and evaluating their quality using the NOS checklist, the overall estimate of the odds ratio of tuberculosis recurrence in smokers was assessed with a 95% confidence interval. RESULTS Fourteen studies met the inclusion criteria. The total number of samples in the group of patients with tuberculosis recurrence was 1988 with 855 (43%) smokers, and in the group of patients affected by tuberculosis without recurrence, it was 27,226 with 7503 (27.56%) smokers. In 13 studies, the odds ratio of tuberculosis recurrence was higher in smokers; this difference was statistically significant in 12 of them. Combining the results of these 14 studies, the odds ratio of tuberculosis recurrence in smokers was 2.10 times higher, using the random effects model (95% CI:1.69, 2.61). CONCLUSION Based on the results of study present, smoking increases the risk of tuberculosis recurrence. Therefore, to eradicate tuberculosis by 2030, more serious interventions should be taken to quit smoking, which in turn reduces the incidence of tuberculosis.
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Affiliation(s)
- Fatemeh Pourali
- Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohammad Khademloo
- Department of Community Medicine, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Siavosh Abedi
- Department of Internal Medicine, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Fatemeh Roozbeh
- Health Deputy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Saeed Barzegari
- Department of Paramedicine, Amol Faculty of Paramedical Sciences, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahmood Moosazadeh
- Gastrointestinal Cancer Research Center, Non-communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.
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Wang XQ, Zhang KD, Yu WJ, Zhao JW, Huang K, Hu CY, Zhang XJ, Kan XH. Associations of exposures to air pollution and greenness with mortality in a newly treated tuberculosis cohort. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:34229-34242. [PMID: 36504301 PMCID: PMC9742034 DOI: 10.1007/s11356-022-24433-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 11/23/2022] [Indexed: 06/17/2023]
Abstract
Some previous studies had linked air pollutants and greenness to the risk of death from tuberculosis (TB). Only a few studies had examined the effect of particulate matter (PM2.5) on the mortality of TB, and few studies had assessed the impact and interaction of multiple air pollutants and greenness on the mortality of newly treated TB patients. The study included 29,519 newly treated TB patients from three cities in Anhui province. We collected meteorological data and five pollutants data from The National Meteorological Science Center and air quality monitoring stations. Greenness data were generated by remote sensing inversion of medium-resolution satellite images. We geocoded each patient based on the residential address to calculate the average exposure to air pollutants and the average greenness exposure for each patient during treatment. The Cox proportional risk regression model was used to evaluate the effects of air pollutants and greenness on mortality in newly treated tuberculosis patients. Our results found that the higher the concentration of air pollutants in the living environment of newly treated TB patients, the greater the risk of death: HR 1.135 (95% CI: 1.123-1.147) and HR 1.333 (95% CI: 1.296-1.370) per 10 μg/m3 of PM2.5 and SO2, respectively. Greenness reduced the mortality among newly treated TB patients: HR for NDVI exposure 0.936 (95% CI: 0.925-0.947), HR for NDVI_250m exposure 0.927 (95% CI: 0.916-0.938), and HR for NDVI_500m exposure 0.919 (95% CI: 0.908-0.931). Stratifying the cohort by median greenness exposure, HRs for air pollutants were lower in the high greenness exposure group. Mortality in newly treated TB patients is influenced by air pollutants and greenness. Higher green exposure can mitigate the effects of air pollution. Improving air quality may help reduce mortality among newly treated TB patients.
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Affiliation(s)
- Xin-Qiang Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Kang-Di Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Wen-Jie Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Jia-Wen Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Kai Huang
- The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, 230601, China
| | - Cheng-Yang Hu
- Department of Humanistic Medicine, School of Humanistic Medicine, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Xiu-Jun Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China
| | - Xiao-Hong Kan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, China.
- Clinical College of Chest, Anhui Chest Hospital, Anhui Medical University, 397 Jixi Road, Hefei, 230022, China.
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Zavala MJ, Becker GL, Blount RJ. Interrelationships between tuberculosis and chronic obstructive pulmonary disease. Curr Opin Pulm Med 2023; 29:104-111. [PMID: 36647566 PMCID: PMC9877200 DOI: 10.1097/mcp.0000000000000938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE OF REVIEW Our objective was to review the current literature regarding socioeconomic, environmental, clinical, and immunologic factors common to chronic obstructive pulmonary disease (COPD) and tuberculosis (TB). RECENT FINDINGS Recent studies suggest that TB patients might be at increased risk for developing COPD. Conversely, additional prospective cohort studies have determined that COPD patients are at increased risk for active TB: a risk that appears to be partially mediated through inhaled corticosteroid use. Tobacco smoking, poverty, air pollution, and malnutrition are associated with COPD and TB. Vitamin D has been shown to prevent COPD exacerbations, but its use for preventing TB infection remains unclear. Surfactant deficiency, elevated matrix metalloproteinases, and toll-like receptor 4 polymorphisms play key roles in the pathogenesis of both diseases. SUMMARY Recent studies have elucidated interrelationships between COPD and TB. Future research is needed to optimize clinical and public health approaches that could mitigate risk factors contributing to both diseases.
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Affiliation(s)
- Michael J Zavala
- Division of Pulmonary and Critical Care Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
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Bay JG, Patsche CB, Svendsen NM, Gomes VF, Rudolf F, Wejse C. Tobacco smoking impact on tuberculosis treatment outcome: an observational study from West Africa. Int J Infect Dis 2022; 124 Suppl 1:S50-S55. [PMID: 35914683 DOI: 10.1016/j.ijid.2022.07.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 07/26/2022] [Accepted: 07/26/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Both tuberculosis (TB) and tobacco smoking are preventable health hazards. Few studies have examined the relationship between TB and tobacco smoking in an African setting, where the two health burdens collide heavily. This study aimed to describe the severity of TB disease and treatment outcomes among smokers with TB compared with nonsmokers with TB in Guinea-Bissau. METHODS We conducted a prospective follow-up study between 2003-2017 in Guinea-Bissau, enrolling adult patients with TB classified as nonsmokers or smokers. Disease severity was assessed using the Bandim TBscore. Multivariate logistic and Cox proportional hazard regressions were used to analyse treatment outcomes. RESULTS Of 1780 included patients, 385 were smokers who had smoked for a median 10 years (interquartile range [IQR] 5-20). No difference in disease severity at the time of diagnosis was observed. Smokers were not significantly more prone to a nonsuccessful treatment outcome, although a trend was seen (adjusted odds ratio [OR] 1.24, 95% confidence interval [CI] 0.91-1.70), and smokers tended to be more often lost to follow-up, but this also was not a significant finding (adjusted hazard ratio [HR] 2.09, 95% CI 0.89-4.94). CONCLUSION In a TB high-endemic setting with few tobacco smokers, smoking was not associated with disease severity or worse outcome, possibly because of socioeconomic confounders.
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Affiliation(s)
- Julie Glerup Bay
- TB research unit, Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau; GloHAU, Centre for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Cecilie Blenstrup Patsche
- TB research unit, Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau; GloHAU, Centre for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark; Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark.
| | - Nicoline Marie Svendsen
- GloHAU, Centre for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | - Frauke Rudolf
- TB research unit, Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau; GloHAU, Centre for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark; Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Christian Wejse
- TB research unit, Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau; GloHAU, Centre for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark; Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
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Tengku Khalid TNF, Wan Mohammad WMZ, Ab Samat R, Nik Husain NR. Predictors of tuberculosis disease in smokers: a case-control study in northeastern Malaysia. PeerJ 2022; 10:e13984. [PMID: 36093335 PMCID: PMC9462367 DOI: 10.7717/peerj.13984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 08/10/2022] [Indexed: 01/21/2023] Open
Abstract
Objective Tuberculosis (TB) is a leading infectious disease. However, many TB cases remain undetected and only present symptoms at a late stage of the infection. Therefore, targeted TB screening in high-risk populations, including smokers, is crucial. This study aimed to determine the predictors of TB disease among the smoker population in northeast Malaysia from 2019 to 2020. Methods A case-control study was conducted involving smokers aged 18 years and older from health clinics in Bachok Kelantan, Malaysia. Data were collected via face-to-face interviews or telephone calls from 159 participants, randomly selected from outpatient TB records. Simple and multiple logistic regression, using R software, were used to identify the determinants of TB. Results Most participants were male (59.1%) and had a secondary education (56.0%). Active smokers constituted 35.2% of the group, and the mean (SD) duration of exposure to smoking was 23.9 (16.47) and 18.4 (12.84) years for the case and control groups, respectively. Being an ex-smoker (adjusted odds ratio (AOR) 6.17; 95% CI [1.55-28.32]; p = 0.013), weight loss (AOR 13.45; 95% CI [4.58-44.46]; p < 0.005), night sweats (AOR 63.84; 95% CI [8.99-1392.75]; p < 0.005) and duration of symptoms (AOR 1.02; 95% CI [1.01-1.04]; p = 0.022) were shown to be significant predictors for TB disease. Conclusion Four predictors of TB disease in the population of smokers were recognised in this study and should be prioritised for early TB screening and diagnosis. This may help increase TB detection, initiate prompt treatment and reduce complications among the group at risk for TB.
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Affiliation(s)
- Tengku Noor Farhana Tengku Khalid
- Universiti Sains Malaysia, Department of Community Medicine, School of Medical Sciences, Health Campus, Kubang Kerian, Kelantan, Malaysia
| | - Wan Mohd Zahiruddin Wan Mohammad
- Universiti Sains Malaysia, Department of Community Medicine, School of Medical Sciences, Health Campus, Kubang Kerian, Kelantan, Malaysia
| | - Razan Ab Samat
- Bachok District Health Office, Bachok, Kelantan, Malaysia
| | - Nik Rosmawati Nik Husain
- Universiti Sains Malaysia, Department of Community Medicine, School of Medical Sciences, Health Campus, Kubang Kerian, Kelantan, Malaysia
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Development and Validation of the Tuberculosis Risk Score for Smokers (TBRSS). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19126959. [PMID: 35742208 PMCID: PMC9223179 DOI: 10.3390/ijerph19126959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/29/2022] [Accepted: 05/30/2022] [Indexed: 02/04/2023]
Abstract
Tuberculosis (TB) remains a significant public health issue worldwide. However, the effectiveness of TB screening programmes among smokers is still questionable. There is a need for a simple, reliable, and validated screening system for this risk population. This study aimed to develop and validate the tuberculosis risk score for smokers (TBRSS) in Kelantan, Malaysia. A case–control study was conducted on 159 patients (smokers with and without TB) between January and July 2020. Simple and multiple logistic regressions were applied to determine the variables to be included in the risk score. The cut-off points to determine a score indicating low or high risk for TB disease were obtained based on the receiver operating characteristics curve. Content validation was carried out through interviews with eight experts to measure each variable′s relevancy. The face validation was conducted among 20 health clinic staff. Seven variables were selected for inclusion in the risk score. The chosen cut-off point was 16 (out of 43), with 91% and 78% sensitivity and specificity, respectively. The scale-level content validity index was 0.83, while the face validity index scores for each element ranged between 0.85 and 1.00. The TBRSS can be considered a validated screening tool for use in screening TB disease risk among smokers, which potentially may lead to an increased detection of TB disease in the community.
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Kim SH, Park YM, Han K, Ko SH, Kim SY, Song SH, Kim CH, Hur KY, Kim SK. Association of weight change following smoking cessation with the risk of tuberculosis development: A nationwide population-based cohort study. PLoS One 2022; 17:e0266262. [PMID: 35390038 PMCID: PMC8989195 DOI: 10.1371/journal.pone.0266262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 03/17/2022] [Indexed: 12/22/2022] Open
Abstract
Background Smoking or weight loss is a risk of tuberculosis (TB) development. However, the impact of weight change after smoking cessation on the occurrence of TB remains elusive. We aimed to determine the relationship between weight change after smoking cessation and the risk of TB development. Methods We conducted a population-based cohort study using the national database in Republic of Korea. Of the 10,490,491 subjects who underwent health check-up in 2009, we enrolled 9,953,124 subjects without a previous TB history and followed them until 2017. We divided all study participants into the following three groups: never, former, and current smokers. The primary endpoint was newly developed TB. Results Among 9,953,124 subjects analyzed, 5,922,845 (59.5%) were never smokers, 1,428,209 (14.4%) were former smokers, and 2,602,080 (26.1%) were current smokers. The risk of TB development was significantly higher in current smokers than in never smokers (adjusted hazard ratio (aHR) 1.158; 95% confidence interval [CI] 1.131–1.186). Among current smokers, individuals who stopped smoking and maintained weight after baseline evaluation had a significantly lower risk of TB development compared with those who continued to smoke (aHR 0.771; 95% CI 0.741–0.892). However, even after smoking cessation, individuals who lost weight were at a significantly higher risk of TB development compared with those who continued to smoke (aHR 1.327; 95% CI 1.119–1.715). Conclusions Our findings suggest that smoking is a risk factor for TB and weight maintenance (neither gaining or losing) after quitting smoking might reduce the risk of TB development.
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Affiliation(s)
- Seung Hoon Kim
- Division of Pulmonology, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Yong-Moon Park
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Seung Hyun Ko
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Shin Young Kim
- Division of Pulmonology, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - So Hyang Song
- Division of Pulmonology, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Chi Hong Kim
- Division of Pulmonology, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Kyu Yeon Hur
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Kyoung Kim
- Division of Pulmonology, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
- * E-mail:
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11
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Why tobacco control should be a priority agenda item of Joint External Monitoring Missions for TB control? Indian J Tuberc 2021; 68S:S93-S100. [PMID: 34538400 DOI: 10.1016/j.ijtb.2021.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/12/2021] [Accepted: 08/18/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Tobacco smoking is a significant risk factor for developing tuberculosis (TB), contributing to diagnostic delays, poor treatment outcomes and an increased risk of death and relapse. The World Health Organization (WHO) has reported that TB rates could decline by as much as 20% if smoking were eliminated. Tobacco smoking was a risk factor in at least 860,000 TB cases in 2018, and has been documented as one of the leading contributors to TB in India, Indonesia, Myanmar, Nepal and Philippines. METHODS Joint External Monitoring Missions (JEMM) are arranged by WHO to review the progress, challenges and plans for national TB control programs and provide guidance for improvement of policies, planning and implementation. During May and June 2021, JEMM reports from five South-East Asian countries that had a JEMM in 2019 and early 2020 were reviewed. Reports reviewed from India, Indonesia, Myanmar, Nepal and the Philippines. Any mention of the association of TB and smoking, TB and tobacco use, impact of tobacco use/smoking on TB outcomes, current practices and challenges of TB and tobacco in the TB control program and proposed actions were documented. RESULTS Of the five country JEMM, Myanmar's did not recognise the impact of smoking tobacco on TB at all, and only one of the five countries, India, identified a very limited number of current TB-Tobacco practises including that a collaborative framework for TB/tobacco was in place. Nepal's 2019 JEMM acknowledged that there was no smoking cessation within the TB Control program and health providers were not aware about the brief advice and smoking cessation program. The Philippines and Myanmar reported neither current practices nor challenges in implementing tobacco intervention in TB control programs. CONCLUSION Given the importance of tobacco smoking as a key risk factor for TB, assessing its burden on the national TB epidemic should be included as one of the key indicators in the JEMM framework. Key interventions include brief cessation support through regular TB services and the use of Nicotine Replacement Therapy (NRT) and other medications as part of a comprehensive package of care for people with TB to improve the quality of the services they receive. Multisectoral efforts to stop smoking also contribute the non-communicable disease agenda as well as protecting against poor outcomes for COVID-19. The support of TB programs to integrate tobacco control is critical and will contribute to national TB control program targets that support WHO's End TB Strategy.
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Pulmonary Tuberculosis and the Incidence of Lung Cancer among Patients with Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc 2021; 19:640-648. [PMID: 34478360 DOI: 10.1513/annalsats.202010-1240oc] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
RATIONALE While the history of pulmonary tuberculosis (PTB) is a risk factor for developing both chronic obstructive pulmonary disease (COPD) and lung cancer, it remains unclear whether the history of PTB affects lung cancer development in COPD patients. OBJECTIVES To investigate whether a history of PTB is associated with an increased risk of lung cancer development in a population with COPD. METHODS This cohort study included a nationwide representative sample of 13,165 Korean men and women with COPD, aged between 50-84 years. In addition, to assess whether the relationship between PTB and lung cancer risk differs between participants with and without COPD, a matched cohort without COPD was included. Participants were matched 1:3 for age, sex, smoking history, and PTB status based on the index health screening exam of corresponding participants with COPD. The two cohorts were followed up for 13 years (January 1st, 2003, to December 31st, 2015). PTB was diagnosed based on the results of chest radiography, and incident lung cancer was identified from hospitalization and outpatient visit claims (International Classification of Diseases, Tenth Revision diagnosis code C33 or C34). RESULTS During 370,617 person-years (PY) of follow-up (median follow-up, 7.7 years), in the COPD group, we observed 430 incident cases of lung cancer in participants without a history of PTB (incidence rate 524 per 100,000 PY) and 148 cases in those with a history of PTB (incidence rate 931 per 100,000 PY). Compared to participants without a PTB history, the fully adjusted subdistribution hazard ratio (95% confidence interval) for lung cancer in those with a history of PTB was 1.24 (1.03, 1.50). The association of PTB history and lung cancer development was more evident in never-smokers with COPD. In contrast, among participants without COPD, the corresponding hazard ratio (95% confidence interval) was 0.98 (0.78, 1.22). There was no interaction between PTB, smoking status, and COPD. CONCLUSIONS The history of PTB was associated with an increased risk of developing lung cancer among COPD patients in our country with an intermediate TB burden. COPD patients with a history of PTB, particularly the never-smokers, might benefit from periodical screening or assessment for lung cancer development.
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13
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Incidence and risk factors of postoperative complications in patients with tuberculosis-destroyed lung. BMC Pulm Med 2021; 21:273. [PMID: 34419012 PMCID: PMC8380317 DOI: 10.1186/s12890-021-01641-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 08/12/2021] [Indexed: 11/10/2022] Open
Abstract
Background The purpose of this study was to determine risk factors of postoperative complications in tuberculosis-destroyed lung (TDL) patients. Methods We retrospectively analyzed the data from all consecutive TDL patients undergoing surgical treatment at the Beijing Chest Hospital from January 2001 to September 2019. Results Of 113 TDL cases experiencing surgery, 33 (29.2%) experienced postoperative complications. The patients with low BMI were more likely to have postoperative complications compared to those with normal BMI, whereas a significant lower rate of postoperative complications was noted in patients with BMI ≥ 25 kg/m2. In addition, significant increased risk was observed in patients with smoking history. We found that the patients with underlying infection, including aspergillus and nontuberculous mycobacteria (NTM), had significantly higher odds of having postoperative complications compared with those without underlying infection. The anaemia was another important independent factor associated with postoperative complication. Patients with blood transfusion above 1000 mL had a strongly increased frequency of postoperative complications than patients with blood transfusion below 1000 mL. Conclusion In conclusion, our data demonstrate that approximate one third of TDL patients experience postoperative complications in our cohort. Patients with low BMI, anaemia, tobacco smoking, and coinfected aspergillus or NTM are at markedly higher risk to experience postoperative complications after pneumonectomy.
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14
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Martial NT, Mubarik S, Yu C. Long-term trends of tuberculosis incidence and mortality in four central African countries. Sci Rep 2021; 11:16624. [PMID: 34404835 PMCID: PMC8371097 DOI: 10.1038/s41598-021-95967-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 07/20/2021] [Indexed: 12/28/2022] Open
Abstract
Tuberculosis (TB) incidence and mortality rates are still high in Sub-Saharan Africa, and the knowledge about the current patterns is valuable for policymaking to decrease the TB burden. Based on the Global Burden of Disease (GBD) study 2019, we used a Joinpoint regression analysis to examine the variations in the trends of TB incidence and mortality, and the age-period-cohort statistical model to evaluate their risks associated with age, period, and cohort in males and females from Cameroon (CAM), Central African Republic (CAR), Chad, and the Democratic Republic of the Congo (DRC). In the four countries, TB incidence and mortality rates displayed decreasing trends in men and women; except for the males from DRC that recorded an almost steady pattern in the trend of TB incidence between 1990 and 2019. TB incidence and mortality rates decreased according to the overall annual percentage changes over the adjusted age category in men and women of the four countries, and CAM registered the highest decrease. Although TB incidence and mortality rates increased with age between 1990 and 2019, the male gender was mainly associated with the upward behaviors of TB incidence rates, and the female gender association was with the upward behaviors of TB mortality rates. Males and females aged between 15–54 and 15–49 years old were evaluated as the population at high risks of TB incidence and mortality respectively in CAM, CAR, Chad, and DRC. The period and cohort relative risks (RRs) both declined in men and women of the four countries although there were some upward behaviors in their trends. Relatively to the period and cohort RRs, females and males from CAM recorded the most significant decrease compared to the rest of the countries. New public health approaches and policies towards young adults and adults, and a particular focus on elderlies’ health and life conditions should be adopted in CAM, CAR, DRC, and Chad to rapidly decrease TB incidence and mortality in both genders of the four countries.
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Affiliation(s)
| | - Sumaira Mubarik
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan, 430071, China
| | - Chuanhua Yu
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan, 430071, China.
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15
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Blount RJ, Phan H, Trinh T, Dang H, Merrifield C, Zavala M, Zabner J, Comellas AP, Stapleton EM, Segal MR, Balmes J, Nhung NV, Nahid P. Indoor Air Pollution and Susceptibility to Tuberculosis Infection in Urban Vietnamese Children. Am J Respir Crit Care Med 2021; 204:1211-1221. [PMID: 34343025 DOI: 10.1164/rccm.202101-0136oc] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE The Southeast Asian tuberculosis burden is high, and it remains unclear if urban indoor air pollution in this setting is exacerbating the epidemic. OBJECTIVES To determine the associations of latent tuberculosis with common urban indoor air pollution sources (secondhand smoke, indoor motorcycle emissions, and cooking) in Southeast Asia. METHODS We enrolled child household contacts of patients with microbiologically confirmed active tuberculosis in Vietnam, July 2017-December 2019. We tested children for latent tuberculosis and evaluated air pollution exposures with questionnaires and personal aerosol sampling. We tested hypotheses using generalized estimating equations. MEASUREMENTS AND MAIN RESULTS We enrolled 72 tuberculosis patients (27% with cavitary disease) and 109 of their child household contacts. Of household contacts, 58 (53%) were diagnosed with latent tuberculosis at baseline visit. Children experienced a 2.56-fold increased odds of latent tuberculosis for each additional household member who smoked (95%CI 1.27-5.16). Odds were highest among children exposed to indoor smokers and children under five years old exposed to household smokers. Each residential floor above street-level pollution decreased the odds of latent tuberculosis by 36% (aOR 0.64, 95%CI 0.42-0.96). Motorcycles parked inside children's homes and cooking with liquid petroleum gas compared to electricity increased the odds of latent tuberculosis while kitchen ventilation decreased the effect, but these findings were not statistically significant. CONCLUSION Common urban indoor air pollution sources were associated with increased odds of latent tuberculosis infection in child household contacts of active tuberculosis patients.
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Affiliation(s)
- Robert J Blount
- UI Carver College of Medicine, 12243, Pulmonary and Critical Care Medicine, Iowa City, Iowa, United States;
| | - Ha Phan
- Vietnam National Tuberculosis Program - University of California San Francisco Research Collaboration Unit, Hanoi, Viet Nam.,Center for Promotion of Advancement of Society, Vietnam, Hanoi, Viet Nam
| | - Trang Trinh
- Vietnam National Tuberculosis Program - University of California San Francisco Research Collaboration Unit, Hanoi, Viet Nam.,Center for Promotion of Advancement of Society, Vietnam, Hanoi, Viet Nam
| | - Hai Dang
- Vietnam National Tuberculosis Program - University of California San Francisco Research Collaboration Unit, Hanoi, Viet Nam.,Center for Promotion of Advancement of Society, Vietnam, Hanoi, Viet Nam
| | - Cindy Merrifield
- University of California San Francisco, 8785, Pulmonary and Critical Care Medicine, San Francisco, California, United States.,University of California San Francisco, 8785, Center for Tuberculosis, San Francisco, California, United States.,Vietnam National Tuberculosis Program - University of California San Francisco Research Collaboration Unit, San Francisco, California, United States
| | - Michael Zavala
- UI Carver College of Medicine, 12243, Pulmonary and Critical Care Medicine, Iowa City, Iowa, United States
| | - Joseph Zabner
- UI Carver College of Medicine, 12243, Pulmonary and Critical Care Medicine, Iowa City, Iowa, United States
| | - Alejandro P Comellas
- University of Iowa, 4083, Pulmonary and Critical Care Medicine, Iowa City, Iowa, United States
| | - Emma M Stapleton
- UI Carver College of Medicine, 12243, Iowa City, Iowa, United States
| | - Mark R Segal
- University of California San Francisco, 8785, Department of Epidemiology and Biostatistics, San Francisco, California, United States
| | - John Balmes
- University of California, Berkeley, Environmental Health Sciences, School of Public Health, Berkeley, California, United States.,University of California, San Francisco, Department of Medicine, San Francisco, California, United States
| | - Nguyen Viet Nhung
- Vietnam National Tuberculosis Program - University of California San Francisco Research Collaboration Unit, Hanoi, Viet Nam.,Vietnam National Tuberculosis Program, Hanoi, Viet Nam
| | - Payam Nahid
- University of California San Francisco, 8785, Pulmonary and Critical Care Medicine, San Francisco, California, United States.,University of California San Francisco, 8785, Center for Turberculosis, San Francisco, California, United States.,Vietnam National Tuberculosis Program - University of California San Francisco Research Collaboration Unit, San Francisco, United States
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16
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Tuberculosis recurrence over a 7-year follow-up period in successfully treated patients in a routine program setting in China: a prospective longitudinal study. Int J Infect Dis 2021; 110:403-409. [PMID: 34332089 DOI: 10.1016/j.ijid.2021.07.057] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/23/2021] [Accepted: 07/24/2021] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES To determine tuberculosis (TB) recurrence in previously successfully treated patients in a routine program setting and baseline characteristics associated with TB recurrence. METHODS A prospective longitudinal study in Jiangxi Province, China. Patients, ≥14 years old, were consecutively registered and were followed up for seven years to assess TB recurrence against a patients' individual baseline data that had been entered into a database at TB registration. RESULTS There were 800 TB patients registered at baseline, and 634 (79.2%) of them completed anti-TB treatments. Fifty-nine (9.3%) died, and 21 (3.3%) were lost to follow-up over the follow-up period. There were 96 patients with recurrent episodes (total incidence 15.2% or annual incidence 2,200/100,000). Of the recurrent cases, 53 (55.2%) happened within 2-year after completion of anti-TB treatments. After controlling confounding factors, the risk of TB recurrence was significantly higher in the age range 34-73 years (P<0.01) and current smokers (P<0.01). CONCLUSIONS Overall recurrence rate among previously treated TB patients was much higher than the initial incidence in the same population (61-98/100,000) and settings with similar TB incidence. TB programs should consider closer monitoring of these patients for early detection of recurrence. Particular attention should be given to those between 34-73 years and those who use tobacco products.
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17
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Lin H, Lin Y, Xiao L, Chen Y, Zeng X, Chang C. How do smoking status and smoking cessation efforts affect TB recurrence after successful completion of anti-TB treatment? A multicentre, prospective cohort study with a 7-year follow-up in China. Nicotine Tob Res 2021; 23:1995-2002. [PMID: 34059890 DOI: 10.1093/ntr/ntab117] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 05/27/2021] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Many important risk factors are associated with tuberculosis (TB) recurrence; among them, smoking is the most common and modifiable behavioural factor. We aimed to assess the association of smoking status and cessation support during anti-TB treatment with subsequent TB recurrence. METHOD A 7-year prospective cohort study was performed on 634 TB patients in China. The participants were grouped by smoking status at baseline. Cox proportional hazards models were applied to analyse the association between baseline characteristics and TB recurrence. The cumulative incidence of TB recurrence was estimated by Kaplan-Meier curves. RESULTS Multivariable analysis showed that patients who continued smoking during anti-TB treatment were at higher risk for TB recurrence (HR= 3.45; 95% CI: 1.54-7.73) than nonsmokers. Moreover, this risk remained significant even in those who stopped smoking during anti-TB treatment (HR = 2.75; 95% CI: 1.47-5.14) than nonsmokers. The association between smoking and TB recurrence was stronger for smear-positive TB patients than for smear-negative TB patients. Among all the subgroups, patients who continued smoking had a higher TB recurrence rate over the 7-year follow-up than those who successfully quit during their anti-TB treatment (log-rank statistic, P< 0.01). With the increase in the number of cigarettes smoked daily, the TB recurrence risk also increased accordingly (log-rank statistic, P= 0.02). CONCLUSION Our findings highlight the importance of incorporating effective smoking cessation intervention measures into TB services and call for continuous monitoring of TB recurrence. Among patients who continue smoking or have a history of smoking, special attention should be given to smear-positive patients and heavy smokers when monitoring recurrence.
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Affiliation(s)
- Haoxiang Lin
- Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Centre, Beijing, China
| | - Yan Lin
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Lixin Xiao
- Xingguo County Tuberculosis Dispensary, Xingguo, China
| | - Yongming Chen
- Xingguo County Tuberculosis Dispensary, Xingguo, China
| | - Xianglin Zeng
- Ningdu County Tuberculosis Dispensary, Ningdu, China
| | - Chun Chang
- Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Centre, Beijing, China
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18
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You N, Pan H, Zeng Y, Lu P, Zhu L, Lu W, Liu Q, Martinez L. A risk score for prediction of poor treatment outcomes among tuberculosis patients with diagnosed diabetes mellitus from eastern China. Sci Rep 2021; 11:11219. [PMID: 34045573 PMCID: PMC8160203 DOI: 10.1038/s41598-021-90664-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 05/13/2021] [Indexed: 11/09/2022] Open
Abstract
Persons living with diabetes (PLWD) with newly diagnosed tuberculosis are at greater risk of poor treatment outcomes. Identifying and prioritizing high-risk subgroups of PLWD and tuberculosis for tuberculosis programs to target has been rarely performed. We investigated risk factors for poor tuberculosis treatment outcomes among PLWD and developed a predictive risk score for tuberculosis control prioritization. Among PLWD diagnosed with tuberculosis, demographic, clinical, and tuberculosis treatment outcome data were collected. Poor treatment outcomes included treatment failure, death, default, and transfer. Multivariable logistic regression modeling was used to analyze risk factors of poor treatment outcomes. Risk scores were derived based on regression coefficients to classify participants at low-, intermediate-, and high-risk of poor treatment outcomes. Among 335 PLWD newly diagnosed with tuberculosis, 109 were cured and 172 completed treatment. Multivariable logistic regression found that risk factors of poor treatment outcomes included bacteriologically-positivity, low body mass index, no physical activity, and pulmonary cavitation. Rates of poor treatment outcomes in low- (0-2), intermediate- (3-4), and high-risk (5-8) groups were 4.2%, 10.5%, and 55.4% (Ptrend < 0.0001), respectively. The risk score accurately discriminated poor and successful treatment outcomes (C-statistic, 0.85, 95% CI 0.78-0.91). We derived a simple predictive risk score that accurately distinguished those at high- and low-risk of treatment failure. This score provides a potentially useful tool for tuberculosis control programs in settings with a double burden of both tuberculosis and diabetes.
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Affiliation(s)
- Nannan You
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu Province, China
- The Second Affiliated Hospital of Zhejiang, Chinese Medical University, Hangzhou, Zhejiang Province, China
| | - Hongqiu Pan
- Department of Tuberculosis, The Third People's Hospital of Zhenjiang Affiliated To Jiangsu University, Zhenjiang, Jiangsu Province, China
| | - Yi Zeng
- Department of Tuberculosis of Three, Nanjing Public Health Medical Center, Nanjing Second Hospital, Nanjing Hospital Affiliated to Nanjing University of Traditional Chinese Medicine, Nanjing, Jiangsu Province, China
| | - Peng Lu
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu Province, China
| | - Limei Zhu
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu Province, China
| | - Wei Lu
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu Province, China
| | - Qiao Liu
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu Province, China.
| | - Leonardo Martinez
- Department of Epidemiology, School of Public Health, Boston University, Boston, MA, USA
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DiNardo AR, Nishiguchi T, Grimm SL, Schlesinger LS, Graviss EA, Cirillo JD, Coarfa C, Mandalakas AM, Heyckendorf J, Kaufmann SHE, Lange C, Netea MG, Van Crevel R. Tuberculosis endotypes to guide stratified host-directed therapy. MED 2021; 2:217-232. [PMID: 34693385 DOI: 10.1016/j.medj.2020.11.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
There is hope that host-directed therapy (HDT) for Tuberculosis (TB) can either shorten treatment duration, help cure drug resistant disease or limit the immunopathology. Many candidate HDT drugs have been proposed, however solid evidence only exists for a few select patient groups. The clinical presentation of TB is variable, with differences in severity, tissue pathology, and bacillary burden. TB clinical phenotypes likely determine the potential benefit of HDT. Underlying TB clinical phenotypes, there are TB "endotypes," defined as distinct molecular profiles, with specific metabolic, epigenetic, transcriptional, and immune phenotypes. TB endotypes can be characterized by either immunodeficiency or pathologic excessive inflammation. Additional factors, like comorbidities (HIV, diabetes, helminth infection), structural lung disease or Mycobacterial virulence also drive TB endotypes. Precise disease phenotyping, combined with in-depth immunologic and molecular profiling and multimodal omics integration, can identify TB endotypes, guide endotype-specific HDT, and improve TB outcomes, similar to advances in cancer medicine.
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Affiliation(s)
- Andrew R DiNardo
- The Global Tuberculosis Program, Texas Children's Hospital, Immigrant and Global Health, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Tomoki Nishiguchi
- The Global Tuberculosis Program, Texas Children's Hospital, Immigrant and Global Health, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Sandra L Grimm
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA.,Molecular and Cellular Biology, Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, USA
| | | | - Edward A Graviss
- Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Houston, TX, USA
| | - Jeffrey D Cirillo
- Department of Microbial and Molecular Pathogenesis, Texas A&M College of Medicine, Bryan, TX, USA
| | - Cristian Coarfa
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA.,Molecular and Cellular Biology, Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, USA
| | - Anna M Mandalakas
- The Global Tuberculosis Program, Texas Children's Hospital, Immigrant and Global Health, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Jan Heyckendorf
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany.,German Center for Infection Research (DZIF) Clinical Tuberculosis Unit, Borstel, Germany.,Respiratory Medicine & International Health, University of Lübeck, Lü beck, Germany
| | - Stefan H E Kaufmann
- Max Planck Institute for Infection Biology, Berlin, Germany.,Hagler Institute for Advanced Study, Texas A&M University, College Station, TX, USA.,Max Planck Institute for Biophysical Chemistry, Am Faßberg 11, 37077 Gö ttingen, Germany
| | - Christoph Lange
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany.,German Center for Infection Research (DZIF) Clinical Tuberculosis Unit, Borstel, Germany.,Respiratory Medicine & International Health, University of Lübeck, Lü beck, Germany
| | - Mihai G Netea
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands.,Department of Immunology and Metabolism, Life & Medical Sciences Institute, University of Bonn, 53115 Bonn, Germany
| | - Reinout Van Crevel
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
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20
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Mukamal KJ. A safe level of alcohol consumption: the right answer demands the right question. J Intern Med 2020; 288:550-559. [PMID: 32529652 DOI: 10.1111/joim.13129] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/05/2020] [Indexed: 01/01/2023]
Abstract
Alcohol has been produced by humans for nearly ten millennia, but gold-standard evidence by which to judge the health effects of limited alcohol consumption remains elusive, introducing serious difficulty in considering the safety of alcohol consumption. To do so, physicians and policymakers must consider the population, dose and context of alcohol consumption and the end-point, preferably a holistic composite, of interest. The limitations of new research trends, such as mega-cohorts, genetic instrumental variable analysis and modelling studies, must also be viewed against the much larger backdrop of existing evidence. Some existing guidelines, such as the 2015-2020 Dietary Guidelines for Americans, succeed remarkably in this task. Nonetheless, large-scale randomized trials are urgently needed if future generations are to enjoy any greater insight into the health effects of population-wide alcohol consumption than the current one has.
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Affiliation(s)
- K J Mukamal
- From the, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
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21
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Co-existence of diabetes and TB among adults in India: a study based on National Family Health Survey data. J Biosoc Sci 2020; 53:758-772. [PMID: 32959732 DOI: 10.1017/s0021932020000516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Multiple studies suggest that diabetes mellitus (DM) is a potential risk factor for tuberculosis (TB) development and treatment, especially in low- and middle-income countries. The study aimed to test concomitancy between DM and TB among adults in India. Data were from the 2015-16 National Family Health Survey (NFHS-4). The study sample comprised 107,575 men aged 15-54 and 677,292 women aged 15-49 for which data on DM status were available in the survey. The association between state-level prevalence of TB and DM was examined and robust Poisson regression analysis applied to examine the effect of DM on TB. A high prevalence of TB was observed among individuals with diabetes in India in 2015-16. A total of 866 per 100,000 men and 405 per 100,000 women who self-reported having diabetes also had TB; among those who self-reported not having diabetes the ratios were 407 per 100,000 men and 241 per 100,000 women. The risk of having TB among those who self-reported having DM was higher for both men (2.03, 95% CI: 1.26, 3.28) and women (1.79, 95% CI: 1.48, 2.49) than for those who did not self-report having DM. Adults who were diagnosed with diabetes (including pre-diabetes) also had a higher rate of TB (477 per 100,000 men and 331 per 100,000 women) than those who were not diagnosed (410 per 100,000 men and 239 per 100,000 women). Adults from poor families, with lower BMIs, lower levels of literacy and who were not working had a higher risk of TB-DM co-morbidity. The state-level pattern of co-morbidity, the under-reporting of DM (undiagnosed) and TB stigmatization are discussed. The study confirms that diabetes is an important co-morbid feature with TB in India, and reinforces the need to raise awareness on screening for the co-existence of DM and TB with integrated health programmes for the two conditions.
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22
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Blount RJ, Pascopella L, Barry P, Zabner J, Stapleton EM, Flood J, Balmes J, Nahid P, Catanzaro DG. Residential urban tree canopy is associated with decreased mortality during tuberculosis treatment in California. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 711:134580. [PMID: 32000313 PMCID: PMC6995452 DOI: 10.1016/j.scitotenv.2019.134580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 09/18/2019] [Accepted: 09/19/2019] [Indexed: 06/10/2023]
Abstract
Trees can sequester air pollutants, and air pollution is associated with poor tuberculosis outcomes. However, the health impacts of urban trees on tuberculosis patients are unknown. To elucidate the effects of urban tree canopy on mortality during tuberculosis treatment, we evaluated patients diagnosed with active tuberculosis in California from 2000 through 2012, obtaining patient data from the California tuberculosis registry. Our primary outcome was all-cause mortality during tuberculosis treatment. We determined percent tree cover using 1 mresolution color infrared orthoimagery categorized into land cover classes, then linked tree cover to four circular buffer zones of 50-300 m radii around patient residential addresses. We used the Kaplan-Meier method to estimate survival probabilities and Cox regression models to determine mortality hazard ratios, adjusting for demographic, socioeconomic, and clinical covariates. Our cohort included 33,962 tuberculosis patients of median age 47, 59% male, 51% unemployed, and 4.9% HIV positive. Tuberculosis was microbiologically confirmed in 79%, and 1.17% were multi-drug resistant (MDR). Median tree cover was 7.9% (50 m buffer). Patients were followed for 23,280 person-years with 2370 deaths during tuberculosis treatment resulting in a crude mortality rate of 1018 deaths per 10,000 person-years. Increasing tree cover quintiles were associated with decreasing mortality risk during tuberculosis treatment in all buffers, and the magnitude of association decreased incrementally with increasing buffer radius: In the 50 m buffer, patients living in neighborhoods with the highest quintile tree cover experienced a 22% reduction in mortality (HR 0.78, 95%CI 0.68-0.90) compared to those living in lowest quintile tree cover; whereas for 100, 200, and 300 m buffers, a 21%, 13%, and 11% mortality risk reduction was evident. In conclusion, urban tree canopy was associated with decreased mortality during tuberculosis treatment even after adjusting for multiple demographic, socioeconomic, and clinical factors, suggesting that trees might play a role in improving tuberculosis outcomes.
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Affiliation(s)
- Robert J Blount
- Division of Pulmonary and Critical Care Medicine, University of Iowa, Iowa City, IA, USA.
| | - Lisa Pascopella
- Tuberculosis Control Branch, California Department of Public Health, Richmond, CA, USA
| | - Pennan Barry
- Tuberculosis Control Branch, California Department of Public Health, Richmond, CA, USA
| | - Joseph Zabner
- Division of Pulmonary and Critical Care Medicine, University of Iowa, Iowa City, IA, USA
| | - Emma M Stapleton
- Division of Pulmonary and Critical Care Medicine, University of Iowa, Iowa City, IA, USA
| | - Jennifer Flood
- Tuberculosis Control Branch, California Department of Public Health, Richmond, CA, USA
| | - John Balmes
- Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, CA, USA; Environmental Health Sciences, University of California, Berkeley, CA, USA
| | - Payam Nahid
- Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, CA, USA
| | - Donald G Catanzaro
- Department of Biological Sciences, University of Arkansas, Fayetteville, AR, USA
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Tobacco smoking as a risk factor for tuberculous pleural effusion: a case-control study. GLOBAL HEALTH EPIDEMIOLOGY AND GENOMICS 2020; 5:e1. [PMID: 32180987 PMCID: PMC7054301 DOI: 10.1017/gheg.2020.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study assessed the tobacco smoking-associated risk for tuberculous pleural effusion (TPE) in India. Ninety-two patients with TPE and 184 controls were randomly selected and assessed regarding their tobacco-smoking status and type, quantity and duration of tobacco used. Odds ratios (ORs) for the association of smoking cigarette, beedi and cigarette or beedi with TPE were 19.22 (p < 0.0001), 2.89 (p = 0.0006) and 4.57 (p < 0.0001) respectively. ORs for developing TPE increased with an increase in beedi/cigarette consumption, duration and pack years of smoking (p < 0.001 each). TPE was significantly associated with confounding risk factors viz., regular alcohol use (OR = 1.89, p = 0.019), history of contact with tuberculosis (TB) patient (OR = 8.07, p < 0.0001), past history of TB (OR = 22.31, p < 0.0001), family history of TB (OR = 9.05, p = 0.0002) and underweight (OR = 3.73, p = 0.0009). Smoking (OR = 3.07, p < 0.001), regular alcohol use (OR = 2.10, p = 0.018), history of contact with TB patient (OR = 4.01, p = 0.040), family history of TB (OR = 10.80, p = 0.001) and underweight (OR = 5.04, p < 0.001) were independently associated with TPE. Thus, both cigarette- and beedi-smoking have a significant association with TPE. The risk for TPE in tobacco smokers is dose- and duration-dependent.
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Soedarsono S, Prinasetyo KWAI, Tanzilia M, Nugraha J. Changes of serum adenosine deaminase level in new cases of pulmonary tuberculosis before and after intensive phase treatment. Lung India 2020; 37:126-129. [PMID: 32108596 PMCID: PMC7065539 DOI: 10.4103/lungindia.lungindia_395_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background and Objectives: Tuberculosis (TB) continues to be a public health crisis with an estimated 10 million people developing TB disease in 2017. Adenosine deaminase (ADA) level in serum and pleural fluid as a biomarker may be used to diagnose pulmonary TB (PTB), but it is not always easy to obtain those samples at the end of treatment. This study was conducted to analyze the changes of serum ADA level in the new case of PTB patients with acid-fast bacilli (AFB) smear-positive sputum and sputum conversion status as treatment monitoring in PTB patients. Materials and Methods: This was a prospective observational analytic study conducted in Dr. Soetomo General Hospital, Surabaya, from January 2018 to May 2018. Participants were all new cases of PTB patients with AFB smear-positive sputum, and a positive rapid molecular test for Mycobacterium tuberculosis. Blood serums were taken at the same time on the 1st day of TB treatment and also taken at the end of intensive phase treatment to analyze the changes of serum ADA level. Results: There were 26 TB patients and 26 healthy control people. Serum ADA level at the beginning of TB treatment was higher than the level at the end of intensive phase treatment. There was a significant difference between serum ADA level before and after the intensive phase of TB treatment (P < 0.001). Conclusions: The examination of serum ADA levels can be used to evaluate the PTB treatment response.
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Affiliation(s)
- Soedarsono Soedarsono
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia
| | | | - Mayfanny Tanzilia
- Department of Clinical Pathology, Faculty of Medicine, Ciputra University, Surabaya, East Java, Indonesia
| | - Jusak Nugraha
- Department of Clinical Pathology, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia
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Tsegaye Sahle E, Blumenthal J, Jain S, Sun S, Young J, Manyazewal T, Woldeamanuel H, Teferra L, Feleke B, Vandenberg O, Rey Z, Briggs-Hagen M, Haubrich R, Amogne W, McCutchan JA. Bacteriologically-confirmed pulmonary tuberculosis in an Ethiopian prison: Prevalence from screening of entrant and resident prisoners. PLoS One 2019; 14:e0226160. [PMID: 31830092 PMCID: PMC6907752 DOI: 10.1371/journal.pone.0226160] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 11/20/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Pulmonary Tuberculosis (PTB) is a major health problem in prisons. Multiple studies of TB in regional Ethiopian prisons have assessed prevalence and risk factors but have not examined recently implemented screening programs for TB in prisons. This study compares bacteriologically-confirmed PTB (BC-PTB) prevalence in prison entrants versus residents and identifies risk factors for PTB in Kality prison, a large federal Ethiopian prison located in Addis Ababa, through a study of an enhanced TB screening program. METHODS Participating prisoners (n = 13,803) consisted of 8,228 entrants screened continuously and 5,575 residents screened in two cross-sectional waves for PTB symptoms, demographics, TB risk factors, and medical history. Participants reporting at least one symptom of PTB were asked to produce sputum which was examined by microscopy for acid-fast bacilli, Xpert MTB/RIF assay and MGIT liquid culture. Prevalence of BC-PTB, defined as evidence of Mycobacterium tuberculosis (MTB) in sputum by the above methods, was compared in entrants and residents for the study. Descriptive analysis of prevalence was followed by bivariate and multivariate analyses of risk factors. RESULTS Prisoners were mainly male (86%), young (median age 26 years) and literate (89%). Prevalence of TB symptoms by screening was 17% (2,334/13,803) with rates in residents >5-fold higher than entrants. Prevalence of BC-PTB detected by screening in participating prisoners was 0.16% (22/13,803). Prevalence in residents increased in the second resident screening compared to the first (R1 = 0.10% and R2 = 0.39%, p = 0.027), but remained higher than in entrants (4.3-fold higher during R1 and 3.1-fold higher during R2). Drug resistance (DR) was found in 38% (5/13) of culture-isolated MTB. Risk factors including being ever diagnosed with TB, history of TB contact and low Body Mass Index (BMI) (<18.5) were significantly associated with BC-PTB (p<0.05). CONCLUSIONS BC-PTB prevalence was strikingly lower than previously reported from other Ethiopian prisons. PTB appears to be transmitted within this prison based on its higher prevalence in residents than in entrants. Whether a sustained program of PTB screening of entrants and/or residents reduces prevalence of PTB in prisons is not clear from this study, but our findings suggest that resources should be prioritized to resident, rather than entrant, screening due to higher BC-PTB prevalence. Detection of multi- and mono-DR TB in both entrant and resident prisoners warrants regular screening for active TB and adoption of methods to detect drug resistance.
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Affiliation(s)
- Eliyas Tsegaye Sahle
- ADDIS-VP Project, Ethiopian Public Health Association, Addis Ababa, Ethiopia
- École de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium
| | - Jill Blumenthal
- University of California San Diego, San Diego, California, United States of America
| | - Sonia Jain
- University of California San Diego, San Diego, California, United States of America
| | - Shelly Sun
- University of California San Diego, San Diego, California, United States of America
| | - Jason Young
- University of California San Diego, San Diego, California, United States of America
| | - Tsegahun Manyazewal
- ADDIS-VP Project, Ethiopian Public Health Association, Addis Ababa, Ethiopia
- Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia
| | | | - Lemma Teferra
- Ethiopian Federal Prison Administration, Addis Ababa, Ethiopia
| | - Beniam Feleke
- Centers for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Olivier Vandenberg
- Environmental and Occupational Health Research Centre (CRSET), School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
- Division of Infection & Immunity, University College London, London, United Kingdom
| | - Zilma Rey
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Melissa Briggs-Hagen
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Richard Haubrich
- Gilead Sciences, Foster City, California, United States of America
| | - Wondwossen Amogne
- ADDIS-VP Project, Ethiopian Public Health Association, Addis Ababa, Ethiopia
- Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia
| | - John Allen McCutchan
- University of California San Diego, San Diego, California, United States of America
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Anaam MS, Alrasheedy AA, Alsahali S, Alfadly SO, Aldhubhani AH. Rate and risk factors of recurrent tuberculosis in Yemen: a 5-year prospective study. Infect Dis (Lond) 2019; 52:161-169. [DOI: 10.1080/23744235.2019.1690162] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Mohammed Saif Anaam
- Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Unaizah, Saudi Arabia
| | - Alian A. Alrasheedy
- Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Unaizah, Saudi Arabia
| | - Saud Alsahali
- Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Unaizah, Saudi Arabia
| | - Saeed O. Alfadly
- Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Unaizah, Saudi Arabia
- Pharmacy Department, College of Medicine and Health Sciences, Hadramout University, Hadramout, Yemen
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Safwat TM, Abdel Fattah EB, Soliman AG. Gender differences in pulmonary tuberculosis in Abbassia Chest Hospital. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2019. [DOI: 10.4103/ejb.ejb_97_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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28
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Thomas BE, Thiruvengadam K, S. R, Kadam D, Ovung S, Sivakumar S, Bala Yogendra Shivakumar SV, Paradkar M, Gupte N, Suryavanshi N, Dolla CK, Gupte AN, Kohli R, Pradhan N, Sivaramakrishnan GN, Gaikwad S, Kagal A, Dhanasekaran K, Deluca A, Golub JE, Mave V, Chandrasekaran P, Gupta A. Smoking, alcohol use disorder and tuberculosis treatment outcomes: A dual co-morbidity burden that cannot be ignored. PLoS One 2019; 14:e0220507. [PMID: 31365583 PMCID: PMC6668833 DOI: 10.1371/journal.pone.0220507] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 07/17/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND More than 20% of tuberculosis (TB) disease worldwide may be attributable to smoking and alcohol abuse. India is the second largest consumer of tobacco products, a major consumer of alcohol particularly among males, and has the highest burden of TB globally. The impact of increasing tobacco dose, relevance of alcohol misuse and past versus current or never smoking status on TB treatment outcomes remain inadequately defined. METHODS We conducted a multi-centric prospective cohort study of newly diagnosed adult pulmonary TB patients initiated on TB treatment and followed for a minimum of 6 months to assess the impact of smoking status with or without alcohol abuse on treatment outcomes. Smokers were defined as never smokers, past smokers or current smokers. Alcohol Use Disorder Identification Test (AUDIT) scores were used to assess alcohol misuse. The association between smoking status and treatment outcomes was assessed in univariate and multivariate random effects poisson regression models. RESULTS Of 455 enrolled, 129 (28%) had a history of smoking with 94 (20%) current smokers and 35 (8%) past smokers. Unfavourable treatment outcomes were significantly higher among past and current smokers as compared to never smokers. Specifically, the risk of treatment failure was significantly higher among past smokers (aIRR = 2.66, 95% CI: 1.41-4.90, p = 0.002), recurrent TB among current smokers (aIRR = 2.94, 95% CI: 1.30-6.67, p = 0.010) and death among both past (2.63, 95% CI: 1.11-6.24, p = 0.028) and current (aIRR = 2.59, 95% CI: 1.29-5.18, p = 0.007) smokers. Furthermore, the combined effect of alcohol misuse and smoking on unfavorable treatment outcomes was significantly higher among past smokers (aIRR: 4.67, 95% CI: 2.17-10.02, p<0.001) and current smokers (aIRR: 3.58, 95% CI: 1.89-6.76, p<0.001). CONCLUSION Past and current smoking along with alcohol misuse have combined effects on increasing the risk of unfavourable TB treatment outcomes. Innovative interventions that can readily address both co-morbidities are urgently needed.
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Affiliation(s)
| | - Kannan Thiruvengadam
- National Institute for Research in Tuberculosis, ICMR, Chennai, Tamil Nadu, India
| | - Rani S.
- National Institute for Research in Tuberculosis, ICMR, Chennai, Tamil Nadu, India
| | - Dileep Kadam
- Byramjee Jeejeebhoy Government Medical College, Pune, Maharashtra, India
| | - Senthanro Ovung
- National Institute for Research in Tuberculosis, ICMR, Chennai, Tamil Nadu, India
| | - Shrutha Sivakumar
- National Institute for Research in Tuberculosis, ICMR, Chennai, Tamil Nadu, India
| | | | - Mandar Paradkar
- Byramjee Jeejeebhoy Government Medical College–Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India
| | - Nikhil Gupte
- Byramjee Jeejeebhoy Government Medical College–Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India
- Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Nishi Suryavanshi
- Byramjee Jeejeebhoy Government Medical College–Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India
| | - C. K. Dolla
- National Institute for Research in Tuberculosis, ICMR, Chennai, Tamil Nadu, India
| | - Akshay N. Gupte
- Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Rewa Kohli
- Byramjee Jeejeebhoy Government Medical College–Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India
| | - Neeta Pradhan
- Byramjee Jeejeebhoy Government Medical College–Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India
| | | | - Sanjay Gaikwad
- Byramjee Jeejeebhoy Government Medical College, Pune, Maharashtra, India
| | - Anju Kagal
- Byramjee Jeejeebhoy Government Medical College, Pune, Maharashtra, India
| | - Kavitha Dhanasekaran
- National Institute for Research in Tuberculosis, ICMR, Chennai, Tamil Nadu, India
| | - Andrea Deluca
- Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Jonathan E. Golub
- Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Vidya Mave
- Byramjee Jeejeebhoy Government Medical College–Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India
- Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | | | - Amita Gupta
- Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Mukhtar F, Butt ZA. Risk of adverse treatment outcomes among new pulmonary TB patients co-infected with diabetes in Pakistan: A prospective cohort study. PLoS One 2018; 13:e0207148. [PMID: 30408109 PMCID: PMC6224090 DOI: 10.1371/journal.pone.0207148] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 10/25/2018] [Indexed: 02/07/2023] Open
Abstract
PURPOSE The escalating burden of diabetes in countries tackling high burden of tuberculosis (TB) has adverse implications for co-infected individuals and National TB control efforts. We aimed to study whether there was a difference in treatment outcome among diabetic and non-diabetic pulmonary TB patients and identify the determinants of treatment outcome among the two groups. MATERIALS AND METHODS This prospective cohort study recruited new patients of pulmonary tuberculosis (PTB) aged 15 years and above who were diagnosed at and registered with Gulab Devi Chest Hospital, Lahore, Pakistan for anti-tuberculosis treatment (ATT). PTB patients were screened for diabetes using random and fasting blood glucose tests. Diabetic and non-diabetic PTB patients were followed up at second, fifth and sixth month of ATT and 6 months after ATT completion to determine treatment outcome. Multivariate logistic regression analysis was conducted to assess association between various factors and treatment outcome. RESULTS Of 614 PTB patients, (n = 113 [18%]) were diabetic and (n = 501 [82%]) non-diabetic. Final model showed that diabetics were more likely to experience an unfavorable outcome as compared to non-diabetics (adjusted odds ratio [aOR] = 2.70, 95% Confidence Interval [CI] = 1.30 to 5.59). Other predictors of unfavorable outcome included rural residence (aOR = 1.98, 95% CI = 1.14 to 3.47), body mass index less than 18.50 (aOR = 1.89, 95% CI = 1.03 to 3.47) and being a smoker (aOR = 2.03, 95%CI = 1.04 to 3.94). CONCLUSION Our study shows unfavorable treatment outcome among diabetic PTB patients. Integrated models of care with screening/testing and management for diabetes and TB could improve TB treatment outcomes.
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Affiliation(s)
- Fatima Mukhtar
- Department of Community Medicine, Lahore Medical & Dental College, Lahore, Pakistan
- Department of Epidemiology & Biostatistics, Health Services Academy, Islamabad, Pakistan
- * E-mail:
| | - Zahid A. Butt
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- Department of Epidemiology & Biostatistics, Health Services Academy, Islamabad, Pakistan
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30
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Depressed Gamma Interferon Responses and Treatment Outcomes in Tuberculosis Patients: a Prospective Cohort Study. J Clin Microbiol 2018; 56:JCM.00664-18. [PMID: 30068533 DOI: 10.1128/jcm.00664-18] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 07/17/2018] [Indexed: 01/07/2023] Open
Abstract
Immunosuppression induced by Mycobacterium tuberculosis is important in the pathogenesis of active tuberculosis (TB). However, the impact of depressed TB-specific and non-TB-specific gamma interferon (IFN-γ) response on the treatment outcomes of TB patients remains uncertain. In this prospective cohort study, culture- or pathology-proven active TB patients were enrolled and QuantiFERON-TB Gold In-Tube (QFT-GIT) assays were performed before the initiation of anti-TB treatment. TB-specific IFN-γ responses (TB antigen tube subtracted from the nil tube) and non-TB-specific IFN-γ responses (mitogen tube subtracted from the nil tube) were measured and associated with treatment outcomes, including 2-month culture conversion and on-treatment mortality. A total of 212 active TB patients were included in the analysis. We observed a close correlation between decreased lymphocyte count and lower non-TB-specific IFN-γ responses but not TB-specific IFN-γ responses. Patients with lower non-TB-specific IFN-γ responses had lower 2-month culture conversion rate (71.1% versus 84.7%, respectively; P = 0.033) and higher on-treatment mortality (22.6% versus 5.7%, respectively; P = 0.001) than those with higher non-TB-specific IFN-γ responses. In multivariate analysis, depressed non-TB-specific IFN-γ response was an independent factor associated with 2-month sputum culture nonconversion (odds ratio [OR], 2.49; 95% CI [95% confidence interval], 1.05 to 5.90) and on-treatment mortality (hazard ratio [HR], 2.76; 95% CI, 1.15 to 6.62). In contrast, depressed TB-specific IFN-γ responses were significantly associated with higher on-treatment mortality in univariate analysis but not in multivariate analysis. Our findings suggest that depressed non-TB-specific responses, but not TB-specific IFN-γ responses, as measured by QFT-GIT before the initiation of anti-TB treatment, were significantly associated with worse treatment outcomes in TB patients.
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31
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Amere GA, Nayak P, Salindri AD, Narayan KMV, Magee MJ. Contribution of Smoking to Tuberculosis Incidence and Mortality in High-Tuberculosis-Burden Countries. Am J Epidemiol 2018; 187:1846-1855. [PMID: 29635332 DOI: 10.1093/aje/kwy081] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 03/29/2018] [Indexed: 12/29/2022] Open
Abstract
Globally, 10 million incident cases of tuberculosis (TB) are reported annually, and 95% of TB cases and 80% of tobacco users reside in low- and middle-income countries. Smoking approximately doubles the risk of TB disease and TB mortality. We estimated the proportion of annual incident TB cases and TB mortality attributable to tobacco smoking in 32 high-TB-burden countries. We obtained country-specific estimates of TB incidence, TB mortality, and smoking prevalence from the World Health Organization Global TB Report (2017), tobacco surveillance reports (2015), and the Tobacco Atlas. Risk ratios for the effect of smoking on TB incidence and TB mortality were obtained from published meta-analyses. An estimated 17.6% (95% confidence interval (CI): 8.4, 21.4) of TB cases and 15.2% (95% CI: 1.8, 31.9) of TB mortality were attributable to smoking. Among high-TB-burden countries, Russia had the highest proportion of smoking-attributable TB disease (31.6%, 95% CI: 15.9, 37.6) and deaths (28.1%, 95% CI: 3.8, 51.4). Men had a greater proportion of TB cases attributable to smoking (30.3%, 95% CI: 14.7, 36.6) than did women (4.3, 95% CI: 1.7, 5.7). Our findings highlight the need for tobacco control in high-TB-burden countries to combat TB incidence and TB mortality.
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Affiliation(s)
- Genet A Amere
- Division of Epidemiology and Biostatistics, School of Public Health, Georgia State University, Atlanta, Georgia
| | - Pratibha Nayak
- Georgia State University’s Tobacco Center of Regulatory Science, School of Public Health, Georgia State University, Atlanta, Georgia
| | - Argita D Salindri
- Division of Epidemiology and Biostatistics, School of Public Health, Georgia State University, Atlanta, Georgia
| | - K M V Narayan
- Emory Global Diabetes Research Center, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Matthew J Magee
- Division of Epidemiology and Biostatistics, School of Public Health, Georgia State University, Atlanta, Georgia
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Bam TS. Impact of tobacco cessation on tuberculosis control. Public Health Action 2018; 8:31. [PMID: 29946516 PMCID: PMC6012954 DOI: 10.5588/pha.18.0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Tara Singh Bam
- Tobacco Control Department International Union Against Tuberculosis and Lung Disease, Singapore
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Senanayake MGB, Wickramasinghe SI, Samaraweera S, De Silva P, Edirippulige S. Examining the social status, risk factors and lifestyle changes of tuberculosis patients in Sri Lanka during the treatment period: a cross-sectional study. Multidiscip Respir Med 2018; 13:9. [PMID: 29619219 PMCID: PMC5878935 DOI: 10.1186/s40248-018-0121-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 02/25/2018] [Indexed: 01/19/2023] Open
Abstract
Background Tuberculosis (TB) is a major global health problem, commonly seen in underdeveloped countries. The probability of contracting the disease is significantly higher among the economically vulnerable and the socially disadvantaged. Risk factors associated with TB can also change over time. In the Sri Lankan context, no study has explored how these factors impact patients. Therefore, we aimed to explore social status, associated risk factors and lifestyle changes during the treatment period of TB patients attending a tertiary respiratory center in Colombo, Sri Lanka. Methods The descriptive cross-sectional study was conducted in 2011. The study population consisted of diagnosed tuberculosis patients above the age of 15 years. Patient records were retrieved from the TB patient registry for the Colombo district. Systematic sampling was used to identify patients to be invited to the study. An interviewer-administered questionnaire was used for data collection. Data were collected on social status (example, level of education, employment, and income), associated risk factors (example, smoking and alcohol consumption, contact history, narcotic drug use) and lifestyle changes during treatment (example, employment status, social interactions). The analysis included a logistic regression model to explore the association between social status and risk factors. Results The total number of patients included in the study was 425. Tuberculosis was found to be strongly prevalent among participants from the lower socio-economic status. It was also common in participants with a low level of education, unemployed, if employed, those who are engaged in unskilled employment and have low levels of income. Risk factors associated with the patients were smoking, alcohol consumptions, narcotic drug use, imprisonment, close contact history with active TB patients and chronic medical conditions. Changes in employment and the reduction of social-interactions were the main lifestyle changes of the participants occurred during the treatment period. The analysis also showed positive correlation between low-level social status and sputum smear infectivity, and use of dangerous drugs. Even after adjusting for confounders, tuberculosis negatively affected social interactions and income levels of participants from the low social status. Conclusion Low socio-economic status negatively affected the lifestyle and social interactions of patients during the treatment period. Though competent treatment programs exist in Sri Lanka, it is still important to identify and mitigate risk factors associated with tuberculosis patients. A comprehensive multi-disciplinary approach considering patient lifestyle, and the implications of the disease and treatment on social interactions may strengthen the current preventive strategies.
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Affiliation(s)
| | - Sumudu Indika Wickramasinghe
- 2Medical officer, Ministry of Health, Sri Lanka and PhD candidate, Centre for Online Health, School of Medicine, The University of Queensland, Brisbane, Australia
| | - Sudath Samaraweera
- Deputy Director, National Programme for Tuberculosis Control and Chest Diseases, Public Health Complex, Colombo, -05 Sri Lanka
| | - Pubudu De Silva
- Consultant Community Physician, Ministry of Health and Indigenous Medicine, Colombo, 10 Sri Lanka
| | - Sisira Edirippulige
- 5Programme Director (e-Healthcare), Centre for Online Health, The University of Queensland, Brisbane, Australia
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Padrão E, Oliveira O, Felgueiras Ó, Gaio AR, Duarte R. Tuberculosis and tobacco: is there any epidemiological association? Eur Respir J 2018; 51:1702121. [PMID: 29371386 DOI: 10.1183/13993003.02121-2017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 10/27/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Eva Padrão
- Pulmonology Dept, Centro Hospitalar de São João, Porto, Portugal
| | | | - Óscar Felgueiras
- Mathematics Dept, Faculty of Sciences of the University of Porto, Porto, Portugal
- Centre of Mathematics of the University of Porto, Porto, Portugal
| | - Ana Rita Gaio
- Mathematics Dept, Faculty of Sciences of the University of Porto, Porto, Portugal
- Centre of Mathematics of the University of Porto, Porto, Portugal
| | - Raquel Duarte
- ISPUP-EPIUnit, Universidade do Porto, Porto, Portugal
- Centro Hospitalar Vila Nova de Gaia/Espinho EPE, Departamento de Pneumologia, Vila Nova de Gaia, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
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Blount RJ, Pascopella L, Catanzaro DG, Barry PM, English PB, Segal MR, Flood J, Meltzer D, Jones B, Balmes J, Nahid P. Traffic-Related Air Pollution and All-Cause Mortality during Tuberculosis Treatment in California. ENVIRONMENTAL HEALTH PERSPECTIVES 2017; 125:097026. [PMID: 28963088 PMCID: PMC5915191 DOI: 10.1289/ehp1699] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 08/18/2017] [Accepted: 08/23/2017] [Indexed: 05/29/2023]
Abstract
BACKGROUND Ambient air pollution and tuberculosis (TB) have an impact on public health worldwide, yet associations between the two remain uncertain. OBJECTIVE We determined the impact of residential traffic on mortality during treatment of active TB. METHODS From 2000-2012, we enrolled 32,875 patients in California with active TB and followed them throughout treatment. We obtained patient data from the California Tuberculosis Registry and calculated traffic volumes and traffic densities in 100- to 400-m radius buffers around residential addresses. We used Cox models to determine mortality hazard ratios, controlling for demographic, socioeconomic, and clinical potential confounders. We categorized traffic exposures as quintiles and determined trends using Wald tests. RESULTS Participants contributed 22,576 person-years at risk. There were 2,305 deaths during treatment for a crude mortality rate of 1,021 deaths per 10,000 person-years. Traffic volumes and traffic densities in all buffers around patient residences were associated with increased mortality during TB treatment, although the findings were not statistically significant in all buffers. As the buffer size decreased, fifth-quintile mortality hazards increased, and trends across quintiles of traffic exposure became more statistically significant. Increasing quintiles of nearest-road traffic volumes in the 100-m buffer were associated with 3%, 14%, 19%, and 28% increased risk of death during TB treatment [first quintile, referent; second quintile hazard ratio (HR)=1.03 [95% confidence interval (CI): 0.86, 1.25]; third quintile HR=1.14 (95% CI: 0.95, 1.37); fourth quintile HR=1.19 (95% CI: 0.99, 1.43); fifth quintile HR=1.28 (95% CI: 1.07, 1.53), respectively; p-trend=0.002]. CONCLUSIONS Residential proximity to road traffic volumes and traffic density were associated with increased all-cause mortality in patients undergoing treatment for active tuberculosis even after adjusting for multiple demographic, socioeconomic, and clinical factors, suggesting that TB patients are susceptible to the adverse health effects of traffic-related air pollution. https://doi.org/10.1289/EHP1699.
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Affiliation(s)
- Robert J Blount
- Division of Pulmonary and Critical Care Medicine, University of California, San Francisco , San Francisco, California, USA
- Division of Pediatric Pulmonology, University of California, San Francisco , San Francisco, California, USA
| | - Lisa Pascopella
- Tuberculosis Control Branch, California Department of Public Health , Richmond, California, USA
| | - Donald G Catanzaro
- Department of Biological Sciences, University of Arkansas , Fayetteville, Arkansas, USA
| | - Pennan M Barry
- Tuberculosis Control Branch, California Department of Public Health , Richmond, California, USA
| | - Paul B English
- Environmental Health Investigations Branch, California Department of Public Health , Richmond, California, USA
| | - Mark R Segal
- Department of Epidemiology and Biostatistics, University of California, San Francisco , San Francisco, California, USA
| | - Jennifer Flood
- Tuberculosis Control Branch, California Department of Public Health , Richmond, California, USA
| | - Dan Meltzer
- California Environmental Health Tracking Program , Public Health Institute , Oakland, California, USA
| | - Brenda Jones
- Division of Infectious Diseases, University of Southern California , Los Angeles, California, USA
| | - John Balmes
- Division of Pulmonary and Critical Care Medicine, University of California, San Francisco , San Francisco, California, USA
- Environmental Health Sciences, University of California, Berkeley , Berkeley, California, USA
| | - Payam Nahid
- Division of Pulmonary and Critical Care Medicine, University of California, San Francisco , San Francisco, California, USA
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Imtiaz S, Shield KD, Roerecke M, Samokhvalov AV, Lönnroth K, Rehm J. Alcohol consumption as a risk factor for tuberculosis: meta-analyses and burden of disease. Eur Respir J 2017; 50:1700216. [PMID: 28705945 PMCID: PMC5540679 DOI: 10.1183/13993003.00216-2017] [Citation(s) in RCA: 133] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 04/08/2017] [Indexed: 11/29/2022]
Abstract
Meta-analyses of alcohol use, alcohol dosage and alcohol-related problems as risk factors for tuberculosis incidence were undertaken. The global alcohol-attributable tuberculosis burden of disease was also re-estimated.Systematic searches were conducted, reference lists were reviewed and expert consultations were held to identify studies. Cohort and case-control studies were included if there were no temporal violations of exposure and outcome. Risk relations (RRs) were pooled by using categorical and dose-response meta-analyses. The alcohol-attributable tuberculosis burden of disease was estimated by using alcohol-attributable fractions.36 of 1108 studies were included. RRs for alcohol use and alcohol-related problems were 1.35 (95% CI 1.09-1.68; I2: 83%) and 3.33 (95% CI 2.14-5.19; 87%), respectively. Concerning alcohol dosage, tuberculosis risk rose as ethanol intake increased, with evidence of a threshold effect. Alcohol consumption caused 22.02 incident cases (95% CI 19.70-40.77) and 2.35 deaths (95% CI 2.05-4.79) per 100 000 people from tuberculosis in 2014. Alcohol-attributable tuberculosis incidence increased between 2000 and 2014 in most high tuberculosis burden countries, whereas mortality decreased.Alcohol consumption was associated with an increased risk of tuberculosis in all meta-analyses. It was consequently a major contributor to the tuberculosis burden of disease.
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Affiliation(s)
- Sameer Imtiaz
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Kevin D Shield
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Michael Roerecke
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Andriy V Samokhvalov
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Knut Lönnroth
- Global TB Programme, World Health Organization, Geneva, Switzerland
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Jürgen Rehm
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute for Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
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Abstract
Background Many low- and middle-income countries are experiencing an epidemiological transition from communicable to non-communicable diseases. This has negative consequences for their human capital development, and imposes a growing economic burden on their societies. While the prevalence of such diseases varies with socioeconomic status, the inequalities can be exacerbated by adopted lifestyles of individuals. Evidence suggests that lifestyle factors may explain the income-related inequality in self-reported health. Self-reported health is a subjective evaluation of people’s general health status rather than an objective measure of lifestyle-related ill-health. Method The objective of this paper is to expand the literature by examining the contribution of smoking and alcohol consumption to health inequalities, incorporating more objective measures of health, that are directly associated with these lifestyle practices. We used the National Income Dynamic Study panel data for South Africa. The corrected concentration index is used to measure inequalities in health outcomes. We use a decomposition technique to identify the contribution of smoking and alcohol use to inequalities in health. Results We find significant smoking-related and income-related inequalities in both self-reported and lifestyle-related ill-health. The results suggest that smoking and alcohol use contribute positively to income-related inequality in health. Smoking participation accounts for up to 7.35% of all measured inequality in health and 3.11% of the inequality in self-reported health. The estimates are generally higher for all measured inequality in health (up to 14.67%) when smoking duration is considered. Alcohol consumption accounts for 27.83% of all measured inequality in health and 3.63% of the inequality in self-reported health. Conclusion This study provides evidence that inequalities in both self-reported and lifestyle-related ill-health are highly prevalent within smokers and the poor. These inequalities need to be explicitly addressed in future programme planning to reduce health inequalities in South Africa. We suggest that policies that can influence poor individuals to reduce tobacco consumption and harmful alcohol use will improve their health and reduce health inequalities.
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Affiliation(s)
- Alfred Kechia Mukong
- Economics of Tobacco Control Project, South African Labour and Development Research Unit (SAL-DRU), School of Economics, University of Cape Town, Rondebosch, South Africa.
| | - Corne Van Walbeek
- Economics of Tobacco Control Project, South African Labour and Development Research Unit (SAL-DRU), School of Economics, University of Cape Town, Rondebosch, South Africa
| | - Hana Ross
- Economics of Tobacco Control Project, South African Labour and Development Research Unit (SAL-DRU), School of Economics, University of Cape Town, Rondebosch, South Africa
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Van Schayck OCP, Williams S, Barchilon V, Baxter N, Jawad M, Katsaounou PA, Kirenga BJ, Panaitescu C, Tsiligianni IG, Zwar N, Ostrem A. Treating tobacco dependence: guidance for primary care on life-saving interventions. Position statement of the IPCRG. NPJ Prim Care Respir Med 2017; 27:38. [PMID: 28600490 PMCID: PMC5466643 DOI: 10.1038/s41533-017-0039-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 03/29/2017] [Accepted: 05/09/2017] [Indexed: 11/12/2022] Open
Abstract
Tobacco smoking is the world's leading cause of premature death and disability. Global targets to reduce premature deaths by 25% by 2025 will require a substantial increase in the number of smokers making a quit attempt, and a significant improvement in the success rates of those attempts in low, middle and high income countries. In many countries the only place where the majority of smokers can access support to quit is primary care. There is strong evidence of cost-effective interventions in primary care yet many opportunities to put these into practice are missed. This paper revises the approach proposed by the International Primary Care Respiratory Group published in 2008 in this journal to reflect important new evidence and the global variation in primary-care experience and knowledge of smoking cessation. Specific for primary care, that advocates for a holistic, bio-psycho-social approach to most problems, the starting point is to approach tobacco dependence as an eminently treatable condition. We offer a hierarchy of interventions depending on time and available resources. We present an equitable approach to behavioural and drug interventions. This includes an update to the evidence on behaviour change, gender difference, comparative information on numbers needed to treat, drug safety and availability of drugs, including the relatively cheap drug cytisine, and a summary of new approaches such as harm reduction. This paper also extends the guidance on special populations such as people with long-term conditions including tuberculosis, human immunodeficiency virus, cardiovascular disease and respiratory disease, pregnant women, children and adolescents, and people with serious mental illness. We use expert clinical opinion where the research evidence is insufficient or inconclusive. The paper describes trends in the use of waterpipes and cannabis smoking and offers guidance to primary-care clinicians on what to do faced with uncertain evidence. Throughout, it recognises that clinical decisions should be tailored to the individual's circumstances and attitudes and be influenced by the availability and affordability of drugs and specialist services. Finally it argues that the role of the International Primary Care Respiratory Group is to improve the confidence as well as the competence of primary care and, therefore, makes recommendations about clinical education and evaluation. We also advocate for an update to the WHO Model List of Essential Medicines to optimise each primary-care intervention. This International Primary Care Respiratory Group statement has been endorsed by the Member Organisations of World Organization of Family Doctors Europe.
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Affiliation(s)
- O C P Van Schayck
- Department of Family Medicine, CAPHRI, Maastricht University, Maastricht, The Netherlands.
| | - S Williams
- International Primary Care Respiratory Group, Aberdeen, UK
| | - V Barchilon
- Andalusian Health Service (SAS), Tobacco group of GRAP (Primary Care Respiratory Group), Andalusia, Spain
| | - N Baxter
- International Primary Care Respiratory Group, Aberdeen, UK
- Southwark Clinical Commissioning Group, London, UK
| | - M Jawad
- Faculty of Medicine, School of Public Health, Imperial College London, London, UK
| | - P A Katsaounou
- Pulmonary Medicine, Medical School, National and Kapodistran University of Athens, Evaggelismos Hospital, Athens, Greece
| | - B J Kirenga
- Lung Institute and Division of Pulmonary Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - C Panaitescu
- Family Medicine Solo Practice, RespiRo- Romanian Primary Care Respiratory Group, Bucharest, Romania
| | - I G Tsiligianni
- Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Crete, Greece
| | - N Zwar
- School of Public Health and Community Medicine, UNSW Australia, Sydney, NSW, Australia
| | - A Ostrem
- General Practitioner, Gransdalen Legesenter, Oslo, Norway
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Cunha R, Maruza M, Montarroyos UR, Coimbra I, de B Miranda-Filho D, Albuquerque MDF, Lacerda HR, Ximenes R. Survival of people living with HIV who defaulted from tuberculosis treatment in a cohort, Recife, Brazil. BMC Infect Dis 2017; 17:137. [PMID: 28187753 PMCID: PMC5303219 DOI: 10.1186/s12879-016-2127-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 12/14/2016] [Indexed: 02/03/2023] Open
Abstract
Background Tuberculosis is a serious public health problem worldwide. It is the leading cause of death amongst people living with HIV, and default from tuberculosis (TB) treatment in people living with HIV increases the probability of death. The aim of this study was to estimate the survival probability of people living with HIV who default treatment for TB compared to those who complete the treatment. Methods This was a longitudinal cohort study of people living with HIV, from June 2007 to December 2013 with two components: a retrospective (for those who started tuberculosis treatment before 2013 for whom failure (death) or censoring occurred before 2013), and prospective (those who started tuberculosis treatment at any time between 2007 and June 2013 and for whom death or censoring occurred after the beginning of 2013), at two referral hospitals for people living with HIV (Correia Picanço Hospital - HCP and at Hospital Universitário Oswaldo Cruz – HUOC), in Recife/PE. A total of 317 patients who initiated TB treatment were studied. Default from TB treatment was defined as any patient who failed to attend their pre-booked return appointment at the health center for more than 30 consecutive days, in accordance with Brazilian Ministry of Health recommendations. Results From a cohort of 2372 people living with HIV we analyzed 317 patients who had initiated TB treatment. The incidence of death was 5.6 deaths per 100 persons per year (CI 95% 4.5 to 7.08). Independent factors associated with death: default from TB treatment 3.65 HR (95% CI 2.28 to 5.83); CD4 < 200 cells/mm3 2.39 HR (95% CI 1.44 to 3.96); extrapulmonary tuberculosis 1.56 HR (95% CI 0.93 to 2.63); smoking 2.28 HR (95% CI 1.33 to 3.89); alcohol light 0.13 HR (95% CI 0.03 to 0.56). Conclusion The probability of death in people living with HIV who default TB treatment is approximately four times greater when compared to those who do not default from treatment.
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Affiliation(s)
- R Cunha
- Department of Clinical Medicine, Universidade de Pernambuco, Rua Arnóbio Marques, 310 -Santo Amaro, Recife, PE CEP: 50100-130, Pernambuco, Brazil.
| | - M Maruza
- Hospital Correia Picanço - HCP - Health State Department, Rua Padre Roma, 149, Tamarineira, Recife, PE CEP: 52050-150, Pernambuco, Brazil
| | - U R Montarroyos
- Department of Clinical Medicine, Universidade de Pernambuco, Rua Arnóbio Marques, 310 -Santo Amaro, Recife, PE CEP: 50100-130, Pernambuco, Brazil
| | - I Coimbra
- Hospital Universitário Oswaldo Cruz- HUOC- UPE, Rua Arnóbio Marques, 310 -Santo Amaro, Recife, PE CEP: 50100-130, Pernambuco, Brazil
| | - D de B Miranda-Filho
- Department of Clinical Medicine, Universidade de Pernambuco, Rua Arnóbio Marques, 310 -Santo Amaro, Recife, PE CEP: 50100-130, Pernambuco, Brazil
| | - M de F Albuquerque
- Aggeu Magalhães Research Center/Fiocruz, Av Moraes Rego, s/n - Campos da UFPE - Cidade Universitária, Recife, PE CEP: 50670420, Pernambuco, Brazil
| | - H R Lacerda
- Post-Graduation Program in Tropical Medicine - Universidade Federal de Pernambuco, Hospital das Clínicas - Bl. A - Térreo do HC/UFPE, Av. Prof. Moraes Rego - s/n. - Cidade Universitária, Recife, PE CEP: 50670-901, Pernambuco, Brazil
| | - Raa Ximenes
- Department of Clinical Medicine, Universidade de Pernambuco, Rua Arnóbio Marques, 310 -Santo Amaro, Recife, PE CEP: 50100-130, Pernambuco, Brazil.,Post-Graduation Program in Tropical Medicine - Universidade Federal de Pernambuco, Hospital das Clínicas - Bl. A - Térreo do HC/UFPE, Av. Prof. Moraes Rego - s/n. - Cidade Universitária, Recife, PE CEP: 50670-901, Pernambuco, Brazil
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Rao V, Bhat J, Yadav R, Muniyandi M, Bhondeley M, Wares D. Smoking and alcohol consumption: Risk factors for pulmonary tuberculosis among the tribal community in central India. ACTA ACUST UNITED AC 2017; 64:40-43. [DOI: 10.1016/j.ijtb.2016.11.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 10/10/2016] [Accepted: 11/01/2016] [Indexed: 12/01/2022]
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El-Shabrawy M, El-Shafei DA. Evaluation of treatment failure outcome and its predictors among pulmonary tuberculosis patients in Sharkia Governorate, 2013–2014. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2017. [DOI: 10.1016/j.ejcdt.2015.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Abstract
Smoking is one of the major health threats and is highly prevalent in Korea. This study quantifies the burden of disease (BOD) resulting from smoking by using the most reliable national statistics of Korea. We followed Global Burden of Disease Study (GBD) 2013 methodology for estimating BOD attributable to smoking. Population attributable fraction was calculated for all diseases and multiplied by disability-adjusted life years (DALYs) to obtain BOD by each disease. Total burden of smoking in Korea was 1 368 072 DALYs (38 per 1000); 68% of the disease burden was in males and 32% in females. The highest percentage of burden was a result of chronic obstructive pulmonary disease in both genders. BOD was highest in the 70- to 74-year-old age group. Smoking burden is substantial in Korea, especially among the elderly population. Tailored health plans for each gender and age should be formulated, and smoking-related burden should be continuously monitored to evaluate the extent of hazard and create priority settings.
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Affiliation(s)
- Aqeela Zahra
- 1 Sungkyunkwan University School of Medicine, Jangan-gu, Suwon, South Korea
| | - Hae-Kwan Cheong
- 1 Sungkyunkwan University School of Medicine, Jangan-gu, Suwon, South Korea
| | - Jae-Hyun Park
- 1 Sungkyunkwan University School of Medicine, Jangan-gu, Suwon, South Korea
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Diabetes Mellitus as Hub for Tuberculosis Infection: A Snapshot. Int J Chronic Dis 2016; 2016:5981574. [PMID: 27819024 PMCID: PMC5080504 DOI: 10.1155/2016/5981574] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 08/16/2016] [Accepted: 09/14/2016] [Indexed: 11/28/2022] Open
Abstract
Tuberculosis (TB) still remains the thorn in the flesh of efficient therapeutics affecting one-third of global population annually. There are several factors that enhance the susceptibility to TB infections including malnutrition, smoking, and immunocompromised conditions such as AIDS. In the recent years, growing body of evidence has gained considerable prominence which suggests that Diabetes Mellitus (DM) is individual risk factor leading to complicated TB infections. In this article the authors have attempted to summarize the link of type 2 DM with TB, the mechanistic action of how DM sensitizes for developing the active TB infection from the latent infection, and problems faced during treatment followed by possible preventive measures. We have tried to give account of the alterations that occurred in DM making a person more prone to develop TB.
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Yi SW, Ohrr H, Shin SA, Yi JJ. Sex-age-specific association of body mass index with all-cause mortality among 12.8 million Korean adults: a prospective cohort study. Int J Epidemiol 2016. [PMID: 26208807 PMCID: PMC4681110 DOI: 10.1093/ije/dyv138] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Despite differences in body shape and adiposity characteristics according to sex and age, a single range of healthy weight [body mass index (BMI, kg/m2) of 18.5–24.9) regardless of sex and age has been recommended. The aim of the study is to examine whether the association between BMI and all-cause mortality varies by sex and age, and, if relevant, to estimate sex-age-specific optimal BMIs associated with a minimal risk of death. Methods: A total of 12 832 637 Korean adults aged 18–99 years who participated in health examinations during 2001–04 were followed up until 2013. Hazard ratios of death in sex-age groups were calculated using Cox regression models after adjustment for age, smoking status and known pre-existing illness. Results: During follow-up, 456 175 men and 241 208 women died. Among men, the age-specific optimal BMI was 23.0–25.9 (kg/m2) at 18–34 years, 24.0–27.9 at 45–54 year, and 25.0–28.9 at 65–74 years. Among women, it was 15.5–24.9 at 18–34 years, 21.0–26.9 at 45–54 years and 24.0–28.9 at 65–74 years. Patterns of sex-age-specific association generally did not differ between never-smokers with no known illness and all participants. Progressively increased risks above and below sex-age-specific optimums were observed (reverse J-curve). Smoking had a limited impact on the observed associations. Conclusions: Women had a lower optimal BMI than men, especially at younger ages. The optimal BMI increased with age. Change in optimal BMI with age, however, was more profound in women than in men. Sex-age-specific optimums were generally higher than the current normal weight (BMI of 18.5–24.9), except in women below 50 years. Sex-age-specific guidelines related to body weight may be needed to guide people for better health.
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Affiliation(s)
- Sang-Wook Yi
- Department of Preventive Medicine and Public Health
- Institute for Clinical and Translational Research, Catholic Kwandong University College of Medicine, Gangneung, Gangwon-do, Republic of Korea
- *Corresponding author. Department of Preventive Medicine and Public Health, Catholic Kwandong University College of Medicine, Bumil-ro 579, Gangneung, Gangwon-do, 210‐701, Republic of Korea. E-mail:
| | - Heechoul Ohrr
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Soon-Ae Shin
- Big Data Steering Department, National Health Insurance Service, Seoul, Republic of Korea and
| | - Jee-Jeon Yi
- Institute for Occupational and Environmental Health, Catholic Kwandong University, Gangneung, Gangwon-do, Republic of Korea
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Hong S, Mok Y, Jeon C, Jee SH, Samet JM. Tuberculosis, smoking and risk for lung cancer incidence and mortality. Int J Cancer 2016; 139:2447-55. [PMID: 27521774 DOI: 10.1002/ijc.30384] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 06/30/2016] [Accepted: 08/04/2016] [Indexed: 12/24/2022]
Abstract
Among the exposures associated with risk for lung cancer, a history of tuberculosis (TB) is one potentially important factor, given the high prevalence of TB worldwide. A prospective cohort study was conducted to evaluate the associations of preexisting pulmonary TB with lung cancer incidence and mortality. The cohort consisted of 1,607,710 Korean adults covered by the National Health Insurance System who had a biennial national medical examination during 1997-2000. During up to 16 years of follow-up, there were 12,819 incident cases of lung cancer and 9,562 lung cancer deaths. Using Cox proportional hazards models and controlling for age, cigarette smoking and other covariates, the presence of underlying TB was significantly associated with increased risk for lung cancer incidence (HR 1.37 in men with 95% CI 1.29-1.45; HR 1.49 in women with 95% CI 1.28-1.74) and mortality (HR 1.43 in men with 95% CI 1.34-1.52; HR 1.53 in women with 95% CI 1.28-1.83). We also observed a dose-response relationship between number of cigarettes smoked daily and lung cancer risk. There was no evidence for synergism between a history of TB and smoking. The elevation in risk is relatively modest, particularly in comparison to that from smoking, and a prior history of TB is not likely to be useful risk indicator for clinical purposes. In populations with high prevalence of TB, it can be considered for incorporation into models for lung cancer risk prediction.
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Affiliation(s)
- Seri Hong
- Department of Public Health, Yonsei University Graduate School, Seoul, Republic of Korea.,Department of Epidemiology and Health Promotion, Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea
| | - Yejin Mok
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.,Department of Epidemiology and Health Promotion, Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea
| | - Christina Jeon
- Department of Public Health, Yonsei University Graduate School, Seoul, Republic of Korea.,Department of Epidemiology and Health Promotion, Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea
| | - Sun Ha Jee
- Department of Epidemiology and Health Promotion, Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea.
| | - Jonathan M Samet
- Department of Preventive Medicine, Keck School of Medicine, Institute for Global Health, University of Southern California, Los Angeles, CA
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Rathee D, Arora P, Meena M, Sarin R, Chakraborty P, Jaiswal A, Goyal M. Comparative study of clinico-bacterio-radiological profile and treatment outcome of smokers and nonsmokers suffering from pulmonary tuberculosis. Lung India 2016; 33:507-11. [PMID: 27625444 PMCID: PMC5006330 DOI: 10.4103/0970-2113.188970] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Tuberculosis (TB) is one of the leading causes of death and disease worldwide. Tobacco smoking has been linked as a risk factor for TB. This study was aimed to affirm the strength of association between smoking and pulmonary TB. MATERIALS AND METHODS Pulmonary TB patients aged between 18 and 65 years were enrolled and followed-up until treatment completion. Two consecutive sputum smears were examined from each patient for the presence of acid-fast bacilli (AFB) using Ziehl-Neelsen technique. Radiological severity of disease was assessed using guidelines of National TB Association of USA. Sputum smears for AFB were graded for positivity as per WHO Revised National TB Control Programme criteria. Response was determined in terms of sputum conversion at the end of intensive phase and final treatment outcomes. RESULTS Sputum smear grading of 3+ increased from 12.5% to 68.18% and 66.66% as smoking index increased from <100 to 100-299 and >300 (P < 0.05). In nonsmokers, 79.2% patients had minimal disease while only 4.2% had advanced disease as compared to smokers where 52.4% had moderate disease, 26.2% advanced disease, and 21.4% minimal disease (P < 0.01). Smokers had significantly lower treatment success rate (69%) as against nonsmokers and former smokers (93.8% and 90.9%, respectively, P = 0.001) owing to a higher default rate among smokers (28.5%) than nonsmokers (6.3%) and former smokers (9.1%). CONCLUSION Smokers during initial presentation, as well as at end of the treatment demonstrate more radiological findings, cavitary disease, and worse sputum AFB smear grading. Smokers also have a poorer treatment success rate largely due to high percentage of default rate thus suggesting noncompliance as a main confounder to treatment success. Focus needs to be made to reduce defaulters which are more common among smokers.
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Affiliation(s)
- Deepti Rathee
- Department of Respiratory Medicine, LRS Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - Piyush Arora
- Department of Respiratory Medicine, LRS Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - Manoj Meena
- Department of Respiratory Medicine, Jawahar Lal Nehru Medical College, Ajmer, Rajasthan, India
| | - Rohit Sarin
- Department of Respiratory Medicine, LRS Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - Pitambar Chakraborty
- Department of Respiratory Medicine, LRS Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - Anand Jaiswal
- Department of Respiratory Medicine, LRS Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - Mukesh Goyal
- Department of Respiratory Medicine, Jawahar Lal Nehru Medical College, Ajmer, Rajasthan, India
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Abstract
Despite astounding economic growth and TB control efforts, incidence remains the highest among high-income countries. After the Korean War (1950–1953), nearly 6.5% of South Korea’s population had active tuberculosis (TB). In response, South Korea implemented the National Tuberculosis Program in 1962. From 1965 to 1995, the prevalence of bacteriologically confirmed pulmonary TB in South Korea decreased from 940 to 219 cases per 100,000 population. Astounding economic growth might have contributed to this result; however, TB incidence in South Korea remains the highest among high-income countries. The rate of decrease in TB incidence seems to have slowed over the past 15 years. A demographic shift toward an older population, many of whom have latent TB and various concurrent conditions, is challenging TB control efforts in South Korea. The increasing number of immigrants also plays a part in the prolonged battle against TB. A historical review of TB in South Korea provides an opportunity to understand national TB control efforts that are applicable to other parts of the world.
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SmokeHaz: Systematic Reviews and Meta-analyses of the Effects of Smoking on Respiratory Health. Chest 2016; 150:164-79. [PMID: 27102185 DOI: 10.1016/j.chest.2016.03.060] [Citation(s) in RCA: 144] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 03/11/2016] [Accepted: 03/30/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Smoking tobacco increases the risk of respiratory disease in adults and children, but communicating the magnitude of these effects in a scientific manner that is accessible and usable by the public and policymakers presents a challenge. We have therefore summarized scientific data on the impact of smoking on respiratory diseases to provide the content for a unique resource, SmokeHaz. METHODS We conducted systematic reviews and meta-analyses of longitudinal studies (published to 2013) identified from electronic databases, gray literature, and experts. Random effect meta-analyses were used to pool the findings. RESULTS We included 216 articles. Among adult smokers, we confirmed substantially increased risks of lung cancer (risk ratio (RR), 10.92; 95% CI, 8.28-14.40; 34 studies), COPD (RR, 4.01; 95% CI, 3.18-5.05; 22 studies), and asthma (RR, 1.61; 95% CI, 1.07-2.42; eight studies). Exposure to passive smoke significantly increased the risk of lung cancer in adult nonsmokers and increased the risks of asthma, wheeze, lower respiratory infections, and reduced lung function in children. Smoking significantly increased the risk of sleep apnea and asthma exacerbations in adult and pregnant populations, and active and passive smoking increased the risk of tuberculosis. CONCLUSIONS These findings have been translated into easily digestible content and published on the SmokeHaz website.
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Almeida-Junior JL, Gil-Santana L, Oliveira CAM, Castro S, Cafezeiro AS, Daltro C, Netto EM, Kornfeld H, Andrade BB. Glucose Metabolism Disorder Is Associated with Pulmonary Tuberculosis in Individuals with Respiratory Symptoms from Brazil. PLoS One 2016; 11:e0153590. [PMID: 27078026 PMCID: PMC4831681 DOI: 10.1371/journal.pone.0153590] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 03/31/2016] [Indexed: 11/18/2022] Open
Abstract
Background Diabetes mellitus (DM) has been associated with increased risk for pulmonary tuberculosis (PTB) in endemic settings but it is unknown whether PTB risk is also increased by pre-DM. Here, we prospectively examined the association between glucose metabolism disorder (GMD) and PTB in patients with respiratory symptoms at a tuberculosis primary care reference center in Brazil. Methods Oral glucose tolerance test was performed and levels of fasting plasma glucose and glycohemoglobin (HbA1c) were measured in a cohort of 892 individuals presenting with respiratory symptoms of more than two weeks duration. Patients were also tested for PTB with sputum cultures. Prevalence of pre-DM and DM (based on HbA1c) was estimated and tested for association with incident PTB. Other TB risk factors including smoking history were analyzed. Results The majority of the study population (63.1%) exhibited GMD based on HbA1c ≥5.7%. Patients with GMD had higher prevalence of PTB compared to normoglycemic patients. Individuals with DM exhibited increased frequency of TB-related symptoms and detection of acid-fast bacilli in sputum smears. Among patients with previous DM diagnosis, sustained hyperglycemia (HbA1c ≥7.0%) was associated with increased TB prevalence. Smoking history alone was not significantly associated with TB in our study population but the combination of smoking and HbA1c ≥7.0% was associated with 6 times higher odds for PTB. Conclusions Sustained hyperglycemia and pre-DM are independently associated with active PTB. This evidence raises the question whether improving glycemic control in diabetic TB patients would reduce the risk of TB transmission and simultaneously reduce the clinical burden of disease. A better understanding of mechanisms underlying these associations, especially those suggesting that pre-DM may be a factor driving susceptibility to TB is warranted.
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Affiliation(s)
- Jilson L. Almeida-Junior
- Unidade de Medicina Investigativa (UMI), Laboratório Integrado de Microbiologia e Imunorregulação (LIMI), Centro de Pesquisas Gonçalo Moniz (CPqGM), Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Bahia, 40296-710, Brazil
- Curso de Medicina, Faculdade de Tecnologia e Ciências (FTC), Salvador, Bahia, 41741-590, Brazil
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Fundação José Silveira, Salvador, Bahia, 40210-320, Brazil
| | - Leonardo Gil-Santana
- Unidade de Medicina Investigativa (UMI), Laboratório Integrado de Microbiologia e Imunorregulação (LIMI), Centro de Pesquisas Gonçalo Moniz (CPqGM), Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Bahia, 40296-710, Brazil
- Curso de Medicina, Faculdade de Tecnologia e Ciências (FTC), Salvador, Bahia, 41741-590, Brazil
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Fundação José Silveira, Salvador, Bahia, 40210-320, Brazil
| | - Carolina A. M. Oliveira
- Centro de Pesquisa, Instituto Brasileiro para Investigação da Tuberculose (IBIT), Fundação José Silveira, Salvador, Bahia, 40210-320, Brazil
| | - Simone Castro
- Centro de Pesquisa, Instituto Brasileiro para Investigação da Tuberculose (IBIT), Fundação José Silveira, Salvador, Bahia, 40210-320, Brazil
| | - Aparecida S. Cafezeiro
- Centro de Pesquisa, Instituto Brasileiro para Investigação da Tuberculose (IBIT), Fundação José Silveira, Salvador, Bahia, 40210-320, Brazil
| | - Carla Daltro
- Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, 40110-060, Brazil
| | - Eduardo M. Netto
- Centro de Pesquisa, Instituto Brasileiro para Investigação da Tuberculose (IBIT), Fundação José Silveira, Salvador, Bahia, 40210-320, Brazil
- Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, 40110-060, Brazil
| | - Hardy Kornfeld
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, 01655, United States of America
| | - Bruno B. Andrade
- Unidade de Medicina Investigativa (UMI), Laboratório Integrado de Microbiologia e Imunorregulação (LIMI), Centro de Pesquisas Gonçalo Moniz (CPqGM), Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Bahia, 40296-710, Brazil
- Curso de Medicina, Faculdade de Tecnologia e Ciências (FTC), Salvador, Bahia, 41741-590, Brazil
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Fundação José Silveira, Salvador, Bahia, 40210-320, Brazil
- Centro de Pesquisa, Instituto Brasileiro para Investigação da Tuberculose (IBIT), Fundação José Silveira, Salvador, Bahia, 40210-320, Brazil
- * E-mail:
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Underner M, Perriot J, Peiffer G, Meurice JC, Dautzenberg B. Tabagisme et observance du traitement antituberculeux. Rev Mal Respir 2016; 33:128-44. [PMID: 26777112 DOI: 10.1016/j.rmr.2015.08.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 08/31/2015] [Indexed: 02/08/2023]
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