Abstract
BackgroundBoth chronic obstructive pulmonary disease (COPD) and tuberculosis (TB) primarily affect the lungs and are major causes of morbidity and mortality worldwide. COPD and TB have common risk factors such as smoking, low socioeconomic status and dysregulation of host defence functions. COPD is a prevalent co-morbid condition, especially in elderly with TB but in contrast to other diseases known to increase the risk of TB, relatively little is known about the specific relationship and impact from COPD on TB-incidence and mortality.Methods and FindingsAll individuals ≥40 years of age, discharged with a diagnosis of COPD from Swedish hospitals 1987–2003 were identified in the Swedish Inpatient Register (n = 115,867). Records were linked to the Swedish Tuberculosis Register 1989–2007 and the relative risk of active TB in patients with COPD compared to control subjects randomly selected from the general population (matched for sex, year of birth and county of residence) was estimated using Cox regression. The analyses were stratified by year of birth, sex and county of residence and adjusted for immigration status, socioeconomic status (SES) and inpatient co-morbidities previously known to increase the risk of TB. COPD patients had a three-fold increased hazard ratio (HR) of developing active TB (HR 3.0 (95% confidence interval 2.4 to 4.0)) that was mainly dependent on an increased risk of pulmonary TB. In addition, logistic regression estimates showed that COPD patients who developed active TB had a two-fold increased risk of death from all causes within first year after the TB diagnosis compared to the general population control subjects with TB (OR 2.2, 95% confidence interval 1.2 to 4.1).ConclusionsThis population-based study comprised of a large number of COPD patients shows that these patients have an increased risk of developing active TB compared to the general population. The results raise concerns that the increasing global burden of COPD will increase the incidence of active TB. The underlying contributory factors need to be disentangled in further studies.
Highlights
Chronic obstructive pulmonary disease (COPD) and tuberculosis (TB) are both diseases that mainly affect the lungs and are major causes of morbidity and mortality worldwide.One third of the world population is infected with Mycobacterium tuberculosis and eight million new cases of TB are reported every year [1]
This population-based study comprised of a large number of chronic obstructive pulmonary disease (COPD) patients shows that these patients have an increased risk of developing active TB compared to the general population
The results raise concerns that the increasing global burden of COPD will increase the incidence of active TB
Summary
Chronic obstructive pulmonary disease (COPD) and tuberculosis (TB) are both diseases that mainly affect the lungs and are major causes of morbidity and mortality worldwide.One third of the world population is infected with Mycobacterium tuberculosis and eight million new cases of TB are reported every year [1]. Chronic obstructive pulmonary disease (COPD) and tuberculosis (TB) are both diseases that mainly affect the lungs and are major causes of morbidity and mortality worldwide. The majority of individuals who develop active TB in Sweden today are either relatively young immigrants from areas with a high incidence of TB or elderly native Swedes who were most probably infected at a younger age and suffer from reactivated TB [2]. In Sweden, approximately 500,000 individuals out of a population of 9 million suffer from COPD[5], and around 2,500 die from COPD annually [6]. Both chronic obstructive pulmonary disease (COPD) and tuberculosis (TB) primarily affect the lungs and are major causes of morbidity and mortality worldwide. COPD is a prevalent co-morbid condition, especially in elderly with TB but in contrast to other diseases known to increase the risk of TB, relatively little is known about the specific relationship and impact from COPD on TB-incidence and mortality
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