Smoking, alcohol use disorder and tuberculosis treatment outcomes

A dual co-morbidity burden that cannot be ignored

CTRIUMPH-RePORT India Study

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)e0220507
JournalPloS one
Volume14
Issue number7
DOIs
StatePublished - Jan 1 2019

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tuberculosis
Tuberculosis
alcohols
Smoking
Alcohols
Morbidity
alcohol abuse
Alcoholism
tobacco
Tobacco
comorbidity
Treatment Failure
cohort studies
Pulmonary Tuberculosis
Tobacco Products
India
Cohort Studies
lungs
Prospective Studies
death

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Smoking, alcohol use disorder and tuberculosis treatment outcomes : A dual co-morbidity burden that cannot be ignored. / CTRIUMPH-RePORT India Study.

In: PloS one, Vol. 14, No. 7, 01.01.2019, p. e0220507.

Research output: Contribution to journalArticle

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title = "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.",
author = "{CTRIUMPH-RePORT India Study} and Thomas, {Beena Elizabeth} and Kannan Thiruvengadam and Rani S and Dileep Kadam and Senthanro Ovung and Shrutha Sivakumar and {Bala Yogendra Shivakumar}, {Shri Vijay} and Mandar Paradkar and Nikhil Gupte and Nishi Suryavanshi and Dolla, {C. K.} and Gupte, {Akshay N.} and Rewa Kohli and Neeta Pradhan and Sivaramakrishnan, {Gomathi Narayan} and Sanjay Gaikwad and Anju Kagal and Kavitha Dhanasekaran and Andrea Deluca and Golub, {Jonathan E} and Vidya Mave and Padmapriyadarshini Chandrasekaran and Amita Gupta",
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T1 - Smoking, alcohol use disorder and tuberculosis treatment outcomes

T2 - A dual co-morbidity burden that cannot be ignored

AU - CTRIUMPH-RePORT India Study

AU - Thomas, Beena Elizabeth

AU - Thiruvengadam, Kannan

AU - S, Rani

AU - Kadam, Dileep

AU - Ovung, Senthanro

AU - Sivakumar, Shrutha

AU - Bala Yogendra Shivakumar, Shri Vijay

AU - Paradkar, Mandar

AU - Gupte, Nikhil

AU - Suryavanshi, Nishi

AU - Dolla, C. K.

AU - Gupte, Akshay N.

AU - Kohli, Rewa

AU - Pradhan, Neeta

AU - Sivaramakrishnan, Gomathi Narayan

AU - Gaikwad, Sanjay

AU - Kagal, Anju

AU - Dhanasekaran, Kavitha

AU - Deluca, Andrea

AU - Golub, Jonathan E

AU - Mave, Vidya

AU - Chandrasekaran, Padmapriyadarshini

AU - Gupta, Amita

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

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