Abstract
BackgroundEvidence of an association between cigarette smoking and latent tuberculosis infection (LTBI) is based on studies in special populations and/or from high prevalence settings. We sought to evaluate the association between LTBI and smoking in a low prevalence TB setting using population-based data from the National Health and Nutrition Examination Survey (NHANES).MethodsIn 1999–2000, NHANES assessed LTBI (defined as a tuberculin skin test measurement ≥10 mm) in participants, and those ≥20 years of age were queried regarding their tobacco use and serum cotinine was measured. We evaluated the association of LTBI with self-reported smoking history and smoking intensity in multivariable logistic regression models that adjusted for known confounders (gender, age, birthplace, race/ethnicity, poverty, education, history of BCG vaccination, and history of household exposure to tuberculosis disease).ResultsEstimated LTBI prevalence was 5.3% among those ≥20 years of age. The LTBI prevalence among never smokers, current smokers, and former smokers was 4.1%, 6.6%, and 6.2%, respectively. In a multivariable model, current smoking was associated with LTBI (OR 1.8; 95% CI, 1.1–2.9). The association between smoking and LTBI was strongest for Mexican-American and black individuals. In multivariate analysis stratified by race/ethnicity, cigarette packs per day among Mexican-American smokers and cotinine levels among black smokers, were significantly associated with LTBI.ConclusionsIn the large, representative, population-based NHANES sample, smoking was independently associated with significantly increased risks of LTBI. In certain populations, a greater risk of LTBI corresponded with increased smoking exposure.
Highlights
One-third of the world’s population is estimated to have latent tuberculosis infection (LTBI) and in 2010, 8.8 million people had tuberculosis disease (TB) [1]
Current smokers had a significantly higher prevalence of LTBI compared to never smokers
Consistent with previously reported estimates, a higher prevalence of LTBI was observed among a number of subgroups including men, foreign-born, non-whites, the poor, less educated, bacillus Calmette-Guerin (BCG) vaccinated, and those with a history of TB exposure [18]
Summary
One-third of the world’s population is estimated to have latent tuberculosis infection (LTBI) and in 2010, 8.8 million people had tuberculosis disease (TB) [1]. In 2007, several systematic reviews identified an association between smoking and TB, calling attention to the potential role of smoking in TB pathogenesis and its contribution to global disease burden [4,5,6,7] For these reasons, WHO recommends tobacco cessation be part of TB control programs [3]. The included studies were limited to special populations, including prisoners, migrant workers, immigrants, and the homeless [9,10,11,12,13], aside from one population-based study that was from a very high TB prevalence setting in South Africa [14]. Evidence of an association between cigarette smoking and latent tuberculosis infection (LTBI) is based on studies in special populations and/or from high prevalence settings. We sought to evaluate the association between LTBI and smoking in a low prevalence TB setting using population-based data from the National Health and Nutrition Examination Survey (NHANES)
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