Prospective study of smoking and tuberculosis in India

Healis, Sekhsaria Institute for Public Health, Navi-Mumbai, India.
Preventive Medicine (Impact Factor: 2.93). 06/2007; 44(6):496-8. DOI: 10.1016/j.ypmed.2007.02.017
Source: PubMed

ABSTRACT Although tuberculosis has already become uncommon in industrialised countries, is a major burden in many developing countries, including India. This paper examines the association between smoking (mainly bidi smoking) and tuberculosis in Mumbai, India.
To study the possible association between smoking and tuberculosis, recruitment of a cohort of 81,443 men > or =35 years began in 1991 and was followed up to the end of 2003 in Mumbai.
The adjusted risk of tuberculosis deaths among bidi smokers was 2.60 (95% confidence interval (CI): 2.02, 3.33) times higher than never-smokers, with a significant trend for daily frequency of bidi smoking. Also the risk of prevalence of self reported tuberculosis among bidi smokers was 5.23 (95% CI: 4.01, 6.82) times higher than never-smokers.
In India around 32% of tuberculosis deaths can be attributable to bidi smoking. Thus, bidi smoking seems to be an important cause of manifestation and death from tuberculosis.

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Available from: Prakash C Gupta, Aug 23, 2015
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    • "For example, smoking is associated with higher relative risk of TB mortality and prevalence of active TB in several studies in rural and urban India [61]. In corroboration of this, increased mortality risk from TB was observed in MCS [74]. Besides the direct physiological effect, tobacco use among the economically disadvantaged is known to reduce the resources available to purchase food, clothing, health, and education, all factors that contribute to poor nutritional status [75]. "
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    ABSTRACT: Background: HIV-infected persons suffering from tuberculosis experience high mortality. No programmatic studies from India have documented the delivery of mortality-reducing interventions, such as cotrimoxazole prophylactic treatment (CPT) and antiretroviral treatment (ART). To guide TB-HIV policy in India we studied the effectiveness of delivering CPT and ART to HIV-infected persons treated for tuberculosis in three districts in Andhra Pradesh, India, and evaluated factors associated with death. Methods and Findings: We retrospectively abstracted data for all HIV-infected tuberculosis patients diagnosed from March 2007 through August 2007 using standard treatment outcome definitions. 734 HIV-infected tuberculosis patients were identified; 493 (67%) were males and 569 (80%) were between the ages of 24–44 years. 710 (97%) initiated CPT, and 351 (50%) collected .60% of their monthly cotrimoxazole pouches provided throughout TB treatment. Access to ART was documented in 380 (51%) patients. Overall 130 (17%) patients died during TB treatment. Patients receiving ART were less likely to die (adjusted hazard ratio [HR] 0.4, 95% confidence interval [CI] 0.3–0.6), while males and those with pulmonary TB were more likely to die (HR 1.7, 95% CI 1.1–2.7, and HR 1.9, 95% CI 1.1–3.2 respectively). Conclusions: Among HIV-infected TB patients in India death was common despite the availability of free cotrimoxazole locally and ART from referral centres. Death was strongly associated with the absence of ART during TB treatment. To minimize death, programmes should promote high levels of ART uptake and closely monitor progress in implementation. This is an open-access article distributed under the terms of the Creative Commons Public Domain declaration which stipulates that, once placed in the public domain, this work may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. Funding: The authors have no support or funding to report. Competing Interests: The authors have declared that no competing interests exist.
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