Abstract
BackgroundTobacco smoking, passive smoking, and indoor air pollution from biomass fuels have been implicated as risk factors for tuberculosis (TB) infection, disease, and death. Tobacco smoking and indoor air pollution are persistent or growing exposures in regions where TB poses a major health risk. We undertook a systematic review and meta-analysis to quantitatively assess the association between these exposures and the risk of infection, disease, and death from TB.Methods and FindingsWe conducted a systematic review and meta-analysis of observational studies reporting effect estimates and 95% confidence intervals on how tobacco smoking, passive smoke exposure, and indoor air pollution are associated with TB. We identified 33 papers on tobacco smoking and TB, five papers on passive smoking and TB, and five on indoor air pollution and TB. We found substantial evidence that tobacco smoking is positively associated with TB, regardless of the specific TB outcomes. Compared with people who do not smoke, smokers have an increased risk of having a positive tuberculin skin test, of having active TB, and of dying from TB. Although we also found evidence that passive smoking and indoor air pollution increased the risk of TB disease, these associations are less strongly supported by the available evidence.ConclusionsThere is consistent evidence that tobacco smoking is associated with an increased risk of TB. The finding that passive smoking and biomass fuel combustion also increase TB risk should be substantiated with larger studies in future. TB control programs might benefit from a focus on interventions aimed at reducing tobacco and indoor air pollution exposures, especially among those at high risk for exposure to TB.
Highlights
Tuberculosis (TB) causes an estimated 2 million deaths per year, the majority of which occur in the developing world
TB control programs might benefit from a focus on interventions aimed at reducing tobacco and indoor air pollution exposures, especially among those at high risk for exposure to TB
Studies were included in the review if they were full-length peer-reviewed reports of cohort studies, case-control studies, or cross-sectional studies, if they controlled for possible confounding by age or age group, and if they screened for the presence of TB among exposed and unexposed study participants in the same way
Summary
Tuberculosis (TB) causes an estimated 2 million deaths per year, the majority of which occur in the developing world. A smaller number have found that indoor air pollution from biomass fuels (IAP) and passive smoking are risk factors for TB and its sequelae. We undertook to quantitatively assess the association between smoking, passive smoking, and IAP, and the risk of infection, disease, and death from TB. Passive smoking, and indoor air pollution from biomass fuels have been implicated as risk factors for tuberculosis (TB) infection, disease, and death. Tobacco smoking and indoor air pollution are persistent or growing exposures in regions where TB poses a major health risk. The researchers were interested in the link between smoking and TB They wanted to try to work out the overall increase in risk for getting TB in people who smoke, as compared with people who do not smoke. The researchers wanted to calculate the association between TB and exposure to indoor pollution from burning fuels such as wood and charcoal
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