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Free Content Smoking increases risk of recurrence after successful anti-tuberculosis treatment: a population-based study

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OBJECTIVE: To investigate whether tobacco smoking increases the risk of tuberculosis (TB) recurrence and identify factors associated with TB recurrence among adults who had successfully completed anti-tuberculosis treatment in Taipei, Taiwan.

METHODS: Recurrence was defined as a new clinical or microbiological diagnosis of TB requiring the start of a new course of treatment in a patient who had satisfactorily completed treatment for a previous TB episode. Cox proportional hazard models were used to calculate adjusted hazard ratios (aHRs) for recurrence.

RESULTS: We followed 5567 adults for recurrence after successful anti-tuberculosis treatment. The mean age was 58.5 years; 62.9% were male. Overall, 84 (1.5%) had a recurrence of TB during follow-up. The incidence of TB recurrence was 4.9 episodes/1000 person-years of follow-up. Cox proportional hazards regression showed that after controlling for other variables, the risk of TB recurrence among subjects who smoked >10 cigarettes a day was double that of never/former smokers. Other independent risk factors significantly associated with TB recurrence were homelessness (aHR 3.75, 95%CI 1.17–12.07), presence of comorbidities (aHR 2.66, 95%CI 1.22–5.79) and a positive acid-fast bacilli smear (aHR 2.27, 95%CI 1.47–3.49).

CONCLUSION: Smoking >10 cigarettes a day was significantly associated with TB recurrence. To reduce the risk of recurrence, we recommend including effective measures of smoking cessation in TB control programmes, as recommended by the World Health Organization Stop TB Strategy.

Keywords: Taiwan; recurrence; smoking; tuberculosis

Document Type: Research Article


Affiliations: 1: Section of Infectious Diseases, Taipei City Hospital, Taipei City Government, Taipei, Taiwan 2: Department of Disease Control and Prevention, Taipei City Hospital, Taipei City Government, Taipei, Taiwan 3: Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan 4: Taipei Databank for Public Health Analysis, Taipei City Hospital, Taipei City Government, Taipei, Taiwan 5: Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan 6: Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan

Publication date: April 1, 2014

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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