Academic journal article Bulletin of the World Health Organization

Tobacco Smoking and Tuberculosis Treatment Outcomes: A Prospective Cohort Study in Georgia

Academic journal article Bulletin of the World Health Organization

Tobacco Smoking and Tuberculosis Treatment Outcomes: A Prospective Cohort Study in Georgia

Article excerpt

Tabagisme et resultats des traitements antituberculeux : etude de cohorte prospective en Georgie

El consumo de tabaco y los resultados del tratamiento de la tuberculosis: un estudio de cohortes prospectivo en Georgia

Introduction

Both tobacco smoking and tuberculosis are major global public health problems. Globally, nearly 6 million people died from tobacco use in 2011 and tobacco use is estimated to be responsible for 16% of deaths among men and 7% of deaths among women each year. (1,2) In 2012, there were an estimated 8.6 million new tuberculosis cases and 1.3 million tuberculosis-related deaths worldwide. (2) Smoking is common in the 22 countries categorized by the World Health Organization (WHO) as high-burden countries for tuberculosis--which together account for more than 80% of all tuberculosis cases. The burden of smoking among patients with tuberculosis is poorly defined in most countries. (2)

An understanding of the epidemiological relationship between smoking and tuberculosis is important because both smoking and tuberculosis cause extensive morbidity and mortality worldwide. Compared with those who have never smoked, it is estimated that people who smoke have approximately twice the risk of both Mycobacterium tuberculosis infection (3) and active tuberculosis. (4) However, data on the impact of smoking on treatment outcomes among patients with active tuberculosis are limited. (5)

Georgia has a high incidence of tuberculosis, a high incidence of multidrug-resistant (MDR) tuberculosis and a high prevalence of smoking. (6,7) In 2012, for example, there were 116 cases of tuberculosis per 100000 people and MDR tuberculosis accounted for 9.2% of the new cases and 31.0% of the retreatment cases. (6) In 2010, a national survey indicated that about 52.8% of Georgian men--including 64.0% of those aged 30-49 years--and 6.1% of Georgian women were smokers. (7) The main objectives of this study were to estimate the prevalence of smoking and the impact of smoking on tuberculosis treatment outcomes among patients with tuberculosis in the Georgian capital of Tbilisi.

Methods

Design and study population

A prospective cohort study was conducted between May 2011 and November 2013 among people attending the National Centre for Tuberculosis and Lung Diseases, or one of its affiliated outpatient clinics, in Tbilisi, Georgia. To be eligible for enrolment, a patient had to be aged at least 18 years, have provided a sputum specimen that had been found either smear-positive for acid-fast bacilli or culture-positive for Mycobacterium tuberculosis and have started directly-observed, standard tuberculosis therapy according to WHO guidelines (8) within the previous two months. Eligible patients were enrolled between May 2011 and February 2012. In November 2013, details of the participants' treatment outcomes were collected from the database of patient records maintained by the National Centre for Tuberculosis and Lung Diseases.

At the time of study enrolment, after the patients had provided written informed consent, our research team conducted face-to-face interviews of eligible inpatients and outpatients. Although most of the data we used were collected using a standardized questionnaire adapted from the one employed in the global adult tobacco survey, (9) additional covariates of interest were collected from the National Centre for Tuberculosis and Lung Diseases database. Self-reported information on age, alcohol use, socioeconomic indicators, prison history, human immunodeficiency virus (HIV) status, exposure to a person with MDR tuberculosis and tuberculosis symptoms --i.e. cough with and without sputum --were recorded on the questionnaire. Previous tuberculosis treatment, results from the examination of a baseline sputum smear and current tuberculosis treatment regimen were obtained from the National Centre for Tuberculosis and Lung Diseases database. …

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