Abstract
Tobacco use and under-nutrition are major public health concerns and tuberculosis is a major cause of morbidity and mortality in India. Using a cohort of 148,173 persons (recruited 1991–1997 and followed-up 1997–2003) the joint effects of tobacco use and BMI on tuberculosis mortality was studied. Tobacco use in any form and low-BMI had joint effect on tuberculosis mortality and the interaction effect was synergistic in men and antagonistic in women. Self-reported tuberculosis was associated with increased risk of tuberculosis mortality. In contrast, no such association was observed for self-reported diabetes persons. The risk pattern remained unchanged even after excluding tuberculosis deaths occurred within 1st two years of follow-up. This study highlights importance of age consideration of individual while excluding early deaths. Around 27% male tuberculosis deaths were attributable to their being underweight and smoker, while 22% male and 37% female deaths were attributable to their being underweight and smokeless tobacco user.
Highlights
Despite the availability of highly efficacious treatment for decades, tuberculosis remains a major global health problem
Mumbai Cohort Study (MCS) was made and reported from India [11,12]. To continue these efforts we report the findings of the joint effect of tobacco use and BMI on tuberculosis mortality
This study shows that 27% male tuberculosis deaths were attributable to their being underweight and smoker; while 22%
Summary
Despite the availability of highly efficacious treatment for decades, tuberculosis remains a major global health problem. In. 2010, there were an estimated 8.5–9.2 million cases and 1.2–. 1.5 million deaths (including deaths from tuberculosis among HIV positive people) [1]. Tuberculosis continues to remain a major burden in developing countries, including India. The WHO estimated that globally the largest burden of tuberculosis deaths in occurred in the South-East Asia Region, which accounted for 40% of incident cases (3.5 million) and 45% of deaths (0.5 million). The estimated incidence rate per 100,000 persons in sub-Saharan Africa was ,50% higher than that of the. India ranks first in terms of both number of incident cases (2.3 million) and deaths (0.32 million); accounted for an estimated one quarter of the total burden, globally [1]. The effect of HIV on tuberculosis in sub-Saharan
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