Published ahead of print on June 19, 2009, doi:10.1164/rccm.200904-0549OC Am. J. Respir. Crit. Care Med., Volume 180, Number 5, September 2009, 475-480 A more recent version of this article appeared on September 1, 2009
Submitted on April 10, 2009 Association Between Tobacco Smoking and Active Tuberculosis in Taiwan: Prospective Cohort StudyHsien-Ho Lin1*,1 Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, United States; Department of Community Health, Mennonite Christian Hospital, Hualien, Taiwan, Province of China, 2 Department of Population and International Health, Harvard School of Public Health, Boston, Massachusetts, United States; Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, United States; Initiative for Global Health, Harvard University, Cambridge, Massachusetts, United States, 3 Center for Health Policy Research and Development, National Health Research Institute, Miaoli, Taiwan, Province of China; Institute of Population Health Science, National Health Research Institute, Miaoli, Taiwan, Province of China, 4 Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, United States; Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts, United States; Division of Social Medicine and Health Inequalities, Brigham and Women's Hospital, Boston, Massachusetts, United States * To whom correspondence should be addressed. E-mail: hsienho{at}gmail.com.
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 years old) 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: 1.94 (95% C.I.: 1.01, 3.73)). The association was stronger among those under 65 years old (adjusted odds ratio: 3.04) than those above 65 years old (adjusted odds ratio: 0.78, Pinteraction =0.036). We found significant dose-response relations for cigarettes per day (Ptrend =0.0036), years of smoking (Ptrend =0.023), and pack-years (Ptrend =0.0023). Conclusions: Tobacco smoking was associated with a two-fold increased risk of active tuberculosis in a representative cohort of Taiwan’s population. Key words: smoking • tuberculosis • cohort studies • Taiwan
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