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Smoking and Tuberculosis among the Elderly in Hong Kong

TB and Chest Service; Elderly Health Service, Department of Health; Department of Community Medicine, The University of Hong Kong; and the TB and Chest Unit, Grantham Hospital, Hong Kong, China

Correspondence and requests for reprints should be sent to Chi Chiu Leung, M.B., F.C.C.P., Wanchai Chest Clinic, 99 Kennedy Road, Wanchai, Hong Kong, China. E-mail: cc_leung{at}dh.gov.hk

A cohort of 42,655 clients that were first registered with the Elderly Health Service in 2000 were followed prospectively through the tuberculosis (TB) notification registry until the end of 2002. A total of 286 active TB cases (186 culture confirmed) were identified. The annual TB notification rates were 735, 427, and 174 per 100,000 among current smokers, ex-smokers, and never-smokers, respectively (p < 0.001). The trend in TB risk persisted after the control of background characteristics using Cox proportional hazards analysis (adjusted hazard ratios [HRs]: 2.63, 1.41, and 1, p < 0.001). In comparison with never-smokers, current smokers had an excess risk of pulmonary TB (adjusted HR, 2.87; 95% confidence interval [CI], 2.00–4.11; p < 0.001), but not extrapulmonary TB (adjusted HR, 1.04; 95% CI, 0.33–3.30; p = 0.95). Among the current smokers, those who developed TB smoked more cigarettes per day than those who did not (13.43, SD 8.76 vs. 10.96, SD 7.87, p = 0.01). A statistically significant dose–response relationship was observed with respect to active TB and culture-confirmed TB (both p < 0.05). Smoking accounted for 32.8% (95% CI, 14.9–48.0%), 8.6% (95% CI, 3.3–15.1%), and 18.7% (95% CI, 7.7–30.4%) of the TB risk among males, females, and the entire cohort, respectively. Approximately 44.9% (95% CI, 20.7–64.6%) of the sex difference was attributable to smoking.

Key Words: Chinese • elderly • notification • smoking • tuberculosis

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