Abstract
BackgroundFew studies assessing the relationship between active and passive smoking and tuberculosis have used biomarkers to measure smoke exposure. We sought to determine the association between active and passive smoking and LTBI in a representative sample of US adults and children.MethodsWe used the 1999–2000 US National Health and Nutrition Examination Survey (NHANES) dataset with tuberculin skin test (TST) data to assess the association between cotinine-confirmed smoke exposure and latent tuberculosis infection (LTBI) among adults ages ≥20 years (n = 3598) and children 3–19 years (n = 2943) and estimate the prevalence of smoke exposure among those with LTBI. Weighted multivariate logistic regression was used to measure the associations between active and passive smoking and LTBI.ResultsLTBI prevalence in 1999–2000 among cotinine-confirmed active, passive, and non-smoking adults and children was 6.0%, 5.2%, 3.3% and 0.3%, 1.0%, 1.5%, respectively. This corresponds to approximately 3,556,000 active and 3,379,000 passive smoking adults with LTBI in the US civilian non-institutionalized population in 1999–2000. Controlling for age, gender, socioeconomic status, race, birthplace (US vs. foreign-born), household size, and having ever lived with someone with TB, adult active smokers were significantly more likely to have LTBI than non-smoking adults (AOR = 2.31 95% CI 1.17–4.55). Adult passive smokers also had a greater odds of LTBI compared with non-smokers, but this association did not achieve statistical significance (AOR = 2.00 95% CI 0.87–4.60). Neither active or passive smoking was associated with LTBI among children. Among only the foreign-born adults, both active (AOR = 2.56 (95% CI 1.20–5.45) and passive smoking (AOR = 2.27 95% CI 1.09–4.72) were significantly associated with LTBI.ConclusionsActive adult smokers and both foreign-born active and passive smokers in the United States are at elevated risk for LTBI. Targeted smoking prevention and cessation programs should be included in comprehensive national and international TB control efforts.
Highlights
Tuberculosis (TB) remains a substantial global health problem, with an estimated one out of every three people worldwide infected with Mycobacterium tuberculosis [1] and 8.6 million incident active cases globally in 2012 [2]
While active or former smoking has been associated with increased risk for latent TB infection (LTBI) [6,7,8,9,10,11,12], including a populationbased national sample in the United States [13], fewer studies have investigated the association between passive smoking and LTBI in adults [14] or children [15,16,17]
All studies reported a positive association between passive smoking and LTBI, though some did not adjust for confounding variables [16,17], and one study found no association after adjusting for confounding variables [15]
Summary
Tuberculosis (TB) remains a substantial global health problem, with an estimated one out of every three people worldwide infected with Mycobacterium tuberculosis [1] and 8.6 million incident active cases globally in 2012 [2]. While active or former smoking has been associated with increased risk for LTBI [6,7,8,9,10,11,12], including a populationbased national sample in the United States [13], fewer studies have investigated the association between passive smoking (secondhand smoke exposure) and LTBI in adults [14] or children [15,16,17]. Among studies that assessed a doseresponse relationship between smoke exposure levels, Shin et al reported an increased risk of LTBI with increased smoke exposure [14] while Horne et al reported a dose-response relationship only among non-Hispanic blacks in the United States but no overall association among adults of all race/ethnicity between past or present smoke exposure and LTBI in a study using the 1999-2000 NHANES dataset [13]. We sought to determine the association between active and passive smoking and LTBI in a representative sample of US adults and children
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