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Association between Tobacco Smoking and Active Tuberculosis in Taiwan

Prospective Cohort Study

¹ Department of Epidemiology, ³ Department of Population and International Health, and ⁴ Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts; ² Department of Community Health, Mennonite Christian Hospital, Hualien, Taiwan; ⁵ Initiative for Global Health, Harvard University, Cambridge, Massachusetts; ⁶ Center for Health Policy Research and Development, National Health Research Institute and ⁷ Institute of Population Health Science, National Health Research Institute, Miaoli, Taiwan; ⁸ Division of Infectious Disease, Massachusetts General Hospital and ⁹ Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts

Correspondence and requests for reprints should be addressed to Hsien-Ho Lin, M.D., Sc.D., Department of Epidemiology, Harvard School of Public Health, 667 Huntington Avenue, Kresge Building Room 801, Boston, MA 02115. E-mail: hhlin{at}hsph.harvard.edu.

Rationale: Previous case-control studies and a small number of cohort studies in high-risk populations have found an association between tobacco and active tuberculosis, but no cohort studies have been conducted in the general population on this association to date.

Objectives: To investigate the association between tobacco smoking and active tuberculosis in a cohort of a general population.

Methods: 17,699 participants (12 y of age) in Taiwan National Health Interview Survey were followed up from 2001 to 2004. Smoking status and other covariates were measured by an in-person interview at baseline. Incident cases of active tuberculosis were identified from the National Health Insurance database. Multivariate logistic regression was used to estimate the association between smoking status and active tuberculosis, with adjustment for age, sex, alcohol consumption, socioeconomic status, and other covariates.

Measurements and Main Results: Fifty-seven new cases of active tuberculosis occurred during the 3.3 years of follow-up. Current smoking was associated with an increased risk of active tuberculosis (adjusted odds ratio [OR], 1.94; 95% confidence interval, 1.01–3.73). The association was stronger among those less than 65 years of age (adjusted OR, 3.04) than those greater than 65 years of age (adjusted OR, 0.78; P_interaction = 0.036). We found significant dose–response relations for cigarettes per day (P_trend = 0.0036), years of smoking (P_trend = 0.023), and pack-years (P_trend = 0.0023).

Conclusions: Tobacco smoking was associated with a twofold increased risk of active tuberculosis in a representative cohort of Taiwan's population.

Key Words: smoking • tuberculosis • cohort study • Taiwan

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject Previous case-control studies and a small number of cohort studies in high-risk populations have found an association between tobacco and active tuberculosis, but no cohort studies have been conducted in the general population on this association to date. What This Study Adds to the Field Tobacco smoking was associated with a twofold increased risk of active tuberculosis in a representative cohort of Taiwan's population. The finding that smoking increases the risk of tuberculosis suggests that tobacco control be considered as an important component in the global effort to eliminate tuberculosis.

 

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