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Solsona, Joan G.; Caylà, Joan A.; Franch-Nadal, Josep; Bedia, M.; Mata, Cristina; J, Brau; Maldonado, José; Milà, Cèlia; Alcaide, J.; Altet, Neus; Galdós-Tangüis, Hernando

doi:10.1023/a:1017580329538

Cited by 32 publications

(13 citation statements)

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“…There was only one case-control study; for the five cross-sectional studies that were included, we found minimal heterogeneity ( I 2 = 0%). We also stratified studies that used different cutoffs for the TST; among those analyses that used induration size of 5 mm as the cutoff for a positive test [32,33], the pooled OR for latent TB was 2.08 (95% CI, 1.53–2.83), while among those that used a 10 mm cutoff [30,31,34,35], the pooled OR was 1.83 (95% CI, 1.49–2.23). When we stratified on other quality-associated study characteristics, we found that ORs for TB infection were lower among studies that adjusted for alcohol (Table 2), but that a positive effect of smoking on latent TB remained.…”

Section: Resultsmentioning

confidence: 99%

“…Another possible source of outcome misclassification was suggested by Plant and colleagues [32], who noted that the frequency of small induration sizes among TSTs was higher among smokers than nonsmokers, suggesting that smokers may be less capable than nonsmokers of eliciting a vigorous skin test reaction and that latent TB infection in smokers may thus be underdetected when the 10 mm cutoff is used. Despite this possible limitation, we found that the two studies of latent infection that used 5 mm cutoffs for the TST [32,33] reported effects that were not statistically different from those that used 10 mm [30,31,34,35]. Finally, the diagnosis of TB in children is notoriously difficult; if children exposed to passive smoke were more likely to be successfully diagnosed with disease than those who were not, this might have introduced a bias that would explain the strong positive association between passive smoking and TB.…”

Section: Discussionmentioning

confidence: 99%

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Tobacco Smoke, Indoor Air Pollution and Tuberculosis: A Systematic Review and Meta-Analysis

Ezzati²,

2007

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Tobacco Smoke, Indoor Air Pollution and Tuberculosis: A Systematic Review and Meta-Analysis

Ezzati²,

2007

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“…In Frankfurt, implementing a voluntary X-ray screening program with the help of local social services had a positive impact on participation and coverage [5]. Other studies showed how cooperation between health and social sectors helps to promote health opportunities for underserved groups of population [8, 25]. As opposed to other infectious diseases, involving peer educators does not seem effective in increasing homeless persons participation screening campaigns for active TB.…”

Section: Discussionmentioning

confidence: 99%

Screening for tuberculosis in an urban shelter for homeless in Switzerland: a prospective study

et al. 2017

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BackgroundWhereas high risk groups such as asylum seekers are systematically screened for active tuberculosis (TB) upon entry in Switzerland, this strategy does not apply to homeless persons despite a reported high risk. Geneva health and social authorities implemented an intersectoral project to screen for active TB in homeless persons. We aimed to assess acceptability of this program and prevalence of active TB in this group.MethodsThis prospective study targeted all homeless adults registering for shelter accommodation in Geneva during winter 2015. Applicants were proposed a questionnaire-based screening (www.tb-screen.ch) exploring epidemiological and clinical risk factors for active TB. Participants with a positive score underwent diagnostic procedures at Geneva University Hospital. Enhanced TB surveillance targeting homeless persons in the community was continued 3 months after the study termination.ResultsOverall, 726/832 (87.3%) homeless persons accepted the screening procedure. Most were young male migrants without access to care in Switzerland. Male gender (adjusted OR: 2.14; 95% confidence interval: 1.27–3.62), age below 25 years (aOR: 4.16; 95% CI: 1.27–13.64) and short duration of homelessness (aOR: 1.75; 95% CI: 1.06–2.87) were predictors of acceptance. Thirty (4.1%) had positive screening scores but none of the 24 who underwent further testing had active TB. Post-study surveillance did not identify any incident case in Geneva.ConclusionsActive TB screening targeting highly mobile homeless persons in shelters was well accepted and feasible. The participants’ sociodemographic profile highlighted the heterogeneity of homeless groups in Europe and the null TB prevalence the variability of their active TB risks. These findings underline the feasibility of health programs targeting this hard to reach group and the need for close monitoring of this social group considering the rapid changes in international mobility patterns to tailor preventive and screening strategies to the local context.

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“…In spite of the accumulated evidence demonstrating a causal relationship between smoking and TB infection, whether smoking cessation in a community level could contribute to TB controlling is still being debated. Because most of the published studies were limited to special populations at high risk of TB infection, including prisoners [8–9], migrant workers [10–11], immigrants [12–13], and the homeless [14]. Furthermore, several studies even reported a negative association between cigarette smoking and TB infection [15–17].…”

Section: Introductionmentioning

confidence: 99%

A dose-response relationship of smoking with tuberculosis infection: A cross-sectional study among 21008 rural residents in China

Zhang

Xin

et al. 2017

PLoS ONE

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ObjectivesChina has high burden on both of tuberculosis (TB) and tobacco use. This study aims to explore the potential link between smoking and TB infection using baseline survey data of a large-scale population-based prospective study in rural ChinaMethodsBetween July 1 and Sept 30, 2013, based on the baseline survey of a population-based, prospective study in rural China, the relationship between smoking and TB infection, assessed by interferon-gamma release assays (IGRA), was investigated among the total study population and only among those smokers, respectively.ResultsA total of 21,008 eligible rural registered residents (≥ 5 years old) from 4 rural sites were included in the analysis. Ever-smokers were more likely to be QuantiFERON-TB Gold In-Tube (QFT) positive than never smokers with an adjusted odds ratio (OR) of 1.34 (95% confidence interval (CI): 1.21–1.49). Among ever smokers, a significant linear dose–response relation was observed between duration of smoking (by years) and QFT positivity (p < 0.001). Stratified analysis suggested that such an association was not influenced by gender and age. Evidence for interaction of smoking status with age was found.ConclusionsOur results provide further evidence to support smoking might increase host susceptibility to TB infection. Populations under high risk of infection, such as elderly smokers, should be prior to TB infection controlling under a premise of community level intervention.

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Abstract: Homeless individuals have a very high risk of TB infection and disease and contact investigation requires specific methods for them. Programmes of screening and supervised treatment should be ensured in this group.

Cited by 32 publications

References 10 publications

Tobacco Smoke, Indoor Air Pollution and Tuberculosis: A Systematic Review and Meta-Analysis

Tobacco Smoke, Indoor Air Pollution and Tuberculosis: A Systematic Review and Meta-Analysis

Screening for tuberculosis in an urban shelter for homeless in Switzerland: a prospective study

A dose-response relationship of smoking with tuberculosis infection: A cross-sectional study among 21008 rural residents in China

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