Smoking, alcohol use disorder and tuberculosis treatment outcomes: A dual co-morbidity burden that cannot be ignored

Abstract

Background More than 20% of tuberculosis (TB) disease worldwide may be attributable to smoking and alcohol abuse. India is the second largest consumer of tobacco products, a major consumer of alcohol particularly among males, and has the highest burden of TB globally. The impact of increasing tobacco dose, relevance of alcohol misuse and past versus current or never smoking status on TB treatment outcomes remain inadequately defined. Methods We conducted a multi-centric prospective cohort study of newly diagnosed adult pulmonary TB patients initiated on TB treatment and followed for a minimum of 6 months to assess the impact of smoking status with or without alcohol abuse on treatment outcomes. Smokers were defined as never smokers, past smokers or current smokers. Alcohol Use Disorder Identification Test (AUDIT) scores were used to assess alcohol misuse. The association between smoking status and treatment outcomes was assessed in univariate and multivariate random effects poisson regression models. Results Of 455 enrolled, 129 (28%) had a history of smoking with 94 (20%) current smokers and 35 (8%) past smokers. Unfavourable treatment outcomes were significantly higher among past and current smokers as compared to never smokers. Specifically, the risk of treatment failure was significantly higher among past smokers (aIRR = 2.66, 95% CI: 1.41–4.90, p = 0.002), recurrent TB among current smokers (aIRR = 2.94, 95% CI: 1.30–6.67, p = 0.010) and death among both past (2.63, 95% CI: 1.11–6.24, p = 0.028) and current (aIRR = 2.59, 95% CI: 1.29–5.18, p = 0.007) smokers. Furthermore, the combined effect of alcohol misuse and smoking on unfavorable treatment outcomes was significantly higher among past smokers (aIRR: 4.67, 95% CI: 2.17–10.02, p<0.001) and current smokers (aIRR: 3.58, 95% CI: 1.89–6.76, p<0.001). Conclusion Past and current smoking along with alcohol misuse have combined effects on increasing the risk of unfavourable TB treatment outcomes. Innovative interventions that can readily address both co-morbidities are urgently needed.

Thyroid profile in pulmonary tuberculosis patients: a prospective study in a tertiary medical college of southern Odisha

“…65% of the patients were found to be male in Thomas et al study. 13 Thomas et al found 28% of their study group was smokers.…”

Prevalence and Associated Factors for Alcohol Use Disorder Among Tuberculosis Patients: A Systematic Review and Meta-analysis.

“…Considering the regional setting where the included studies were done; six (17,25,35,37,38,48), ve (41,46,47,49,50) and another ve studies were from Russia, South Africa (33,34,51,52,54) and Ethiopia (33,34,51,52,54) respectively. The remaining studies were from United States (US) (36,39), Estonia (42,43), India (14,44,53), Thailand (45), Nigeria (40), Botswana (15) and Zambia (11). Most of the studies in the present analysis were Cohort (25,35,38,41,45,47,49,(52)(53)(54) and cross-sectional (11,14,17,33,34,36,37,42,…”

“…The remaining studies were from United States (US) (36,39), Estonia (42,43), India (14,44,53), Thailand (45), Nigeria (40), Botswana (15) and Zambia (11). Most of the studies in the present analysis were Cohort (25,35,38,41,45,47,49,(52)(53)(54) and cross-sectional (11,14,17,33,34,36,37,42,44,46,50,51).…”

“…One -third of the studies included (14,15,17,25,34,39,(45)(46)(47)(48)(49)(50)(52)(53)(54) used Alcohol use disorder identi cation test (AUDIT) to measure alcohol use disorder in tuberculosis patients. Besides two studies (11, 40) measured AUD with mini-international neuropsychiatric-interview(MINI), one (33) with alcohol, smoking, and substance involvement screening test(ASSIST)and another one used DSM-IV (37).…”

The first results nicotine dependence treatment by varenicline in patients with tuberculosis

“…В многоцентровом проспективном когортном исследовании взрослых пациентов с туберкулезом легких было продемонстрировано, что риск рецидива ТБ среди курящих был выше в 2,94 раза (RR=2,94; 95% ДИ 1,30-6,67; p=0,010), а смертность -в 2,59 раза по сравнению с некурящими (RR=2,59; 95% ДИ 1,29-5,18; р=0,007). Кроме того, злоупотребление алкоголем наряду с курением увеличивает риски неблагоприятных результатов лечения в 3,58 раза (RR=3,58; 95% ДИ 1,89-6,76; р<0,001) [5].…”