Abstract
BackgroundSmoking is known to aggravate tuberculosis (TB), but such information has been ignored in clinical practice, as it was not thought to be relevant. The aim of this study is to assess the benefits of smoking cessation on TB mortality reduction.MethodsThe study attempts to quantify smokers' risks on subsequent TB mortality and the change in such risks after smokers quit smoking. In this prospective cohort study, the TB mortality risks of smokers, never smokers and former smokers were compared, by using the Cox proportional model to estimate the hazard ratio (HR) of TB.The cohort, consisting of 486,341 adults, participated in standard medical screening programs since 1994, including 5,036 with self-reported TB history. Of 15,268 deaths identified as of 2007, 77 were coded as TB.ResultsSmokers with self-reported TB history (1.2%) had very high TB mortality (HR = 44.02). Among those without self-reported TB history, smoking increased TB mortality by nine-fold (HR = 8.56), but when they quit smoking, the risk was reduced by more than half (65%), to a level not different from those who had never smoked. The overwhelming majority of TB deaths (83%) occurred among those without self-reported TB history. Given the high smoking prevalence and the high HR, smoking accounted for more than one-third (37.7%) of TB mortality in Taiwan. Smokers reported less TB history but died more from TB than those who had never smoked.ConclusionsSmokers had very high TB mortality, as much as nine times those who had never smoked, but once they quit, the risk reduced substantially and was similar to those who never smoked. Smoking cessation has benefits to the smokers far beyond reducing TB risk, but successful tobacco control could favorably impact the TB mortality rate and reduce this public health burden, which has long haunted the Taiwanese population. Smoking cessation could reduce nearly one-third of tuberculosis deaths.
Highlights
Smoking is known to aggravate tuberculosis (TB), but such information has been ignored in clinical practice, as it was not thought to be relevant
Background the relationship between smoking and TB has been extensively reviewed [1,2,3,4,5], most studies have determined that a strong relationship exists between smoking and TB based more on case control study design than cohort one, studying more active TB diseases than TB deaths [2]
The relationship took on an increasing importance in China where the interaction on outcome between tens of millions of TB patients, some known but mostly unknown, and 350 million smokers [21] is largely ignored, and the potential to reduce the large number of TB deaths in China, estimated at 200,000 in a given year, has been left unexplored [14]
Summary
Smoking is known to aggravate tuberculosis (TB), but such information has been ignored in clinical practice, as it was not thought to be relevant. As there was limited evidence on TB mortality from cohort studies [6,7,8], the clinical significance of Smoking caused 5 million deaths a year [13], and tuberculosis, nearly 2 million deaths a year [2]. The relationship took on an increasing importance in China where the interaction on outcome between tens of millions of TB patients, some known but mostly unknown, and 350 million smokers [21] is largely ignored, and the potential to reduce the large number of TB deaths in China, estimated at 200,000 in a given year, has been left unexplored [14]. Health care workers focused on TB have rarely considered the impact of smoking cessation on these patients
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