Review of cigarette smoking and tuberculosis in China: intervention is needed for smoking cessation among tuberculosis patients

Jianming Wang,Hongbing Shen

doi:10.1186/1471-2458-9-292

Jianming Wang, Hongbing Shen

Open Access

https://doi.org/10.1186/1471-2458-9-292

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Abstract

BackgroundAs a risk factor of tuberculosis (TB), tobacco smoking has increased substantially over the past three decades, especially in developing countries. However, the association between smoking and TB, which has been shown to exist in different studies with different ethnic background, has not yet received sufficient attention in terms of TB care standards and research in China.MethodsAn observational study was conducted in two rural areas of China. A total of 613 TB patients frequency matched with 1226 controls were interviewed by using a structured questionnaire. The associations between cigarette smoking and risk of TB were estimated by computing odds ratios (ORs) and 95% confidence intervals (95% CIs) from logistic regression model. Patients' smoking behavior and patterns of smoking cessation were followed after TB diagnosis. Multivariate Cox proportional hazards model was applied to calculate hazard ratios (HRs) and 95% confidence intervals (95% CIs) in analyzing the risk factors for smoking relapse. The Kaplan-Meier estimate was computed to plot the ability of smoking-free after cessation among different groups, with the Log-rank test being used to compare the difference.ResultsThe proportion of cigarette smoking was 54.6% in TB cases, which was significantly higher than that in controls (45.1%) with adjusted OR of 1.93(95% CI: 1.51–2.48). Though 54.9% smokers stopped smoking after being diagnosed with TB, more than 18% relapsed during the follow-up period. The proportion of relapse was higher within 6–9 months (6%) and 12–15 months (11%) after cessation. In the Cox regression estimates adjusted for age and gender, compared with those highly educated and previously treated patients, the hazard ratios of smoking relapse were 3.48(95% CI: 1.28–9.47) for less educated (< 6 years) and 4.30(95% CI: 1.01–18.30) for newly treated patients, respectively.ConclusionCigarette smoking is associated with TB in the Chinese. Interventions of smoking cessation are recommended to be included in the current TB control practice.

Highlights

As a risk factor of tuberculosis (TB), tobacco smoking has increased substantially over the past three decades, especially in developing countries
We aim to investigate the cigarette smoking behavior among TB patients and smoking cessation after diagnosis, and to identify factors associated with smoking relapse among quitters
To evaluate the effects of cigarette smoking on TB risk according to selected variables, stratified analysis was performed

Summary

Introduction

As a risk factor of tuberculosis (TB), tobacco smoking has increased substantially over the past three decades, especially in developing countries. Tuberculosis (TB) is one of the leading causes of death in the world and remains a major public health burden in many developing countries [1]. As a risk factor of TB, tobacco smoking has increased substantially over the past three decades, especially in developing countries [3,4]. Studies investigating the association between smoking and TB have been published since 1918 [6]. Both passive and active exposures to tobacco smoke have been shown to be associated with TB infection and the transition from being infected to developing TB disease. Thomas investigated predictors of recurrence among TB patients in South India and showed that a higher relapse rate was independently associated with smoking (OR: 3.1, 95% CI: 1.6–6.0) [8]

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