Tobacco smoking and tuberculosis treatment outcomes: a prospective cohort study in Georgia

• Type of Material: Article
• Authors: Medea Gegia, United States Agency for International Development; Matthew James Magee, Emory University; Russell Ryan Kempker, Emory University; Iagor Kalandadze, Gudushauri National Medical Centre; Tsira Chakhaia, United States Agency for International Development; Jonathan E Golub, Johns Hopkins University; Henry Blumberg, Emory University
• Language: English
• Date: 2015-06-01
• Publisher: World Health Organization (WHO): Creative Commons Attribution
• Publication Version: Final Published Version
• Copyright Statement: © 2015, World Health Organization. All Rights Reserved.
• License: Creative Commons Attribution 3.0 IGO License
• Final Published Version (URL): http://dx.doi.org/10.2471/BLT.14.147439
• Title of Journal or Parent Work: Bulletin of the World Health Organization
• ISSN: 0042-9686
• Volume: 93
• Issue: 6
• Start Page: 390
• End Page: 399
• Grant/Funding Information: This work was supported in part by the Johns Hopkins Institute for Global Tobacco Control; the Bloomberg Initiative to Reduce Tobacco Control; the United States National Institute of Health Fogarty International Center (D43TW007124); United States National Institute of Allergy and Infectious Diseases (K23AI1030344); the Atlanta Clinical and Translational Science Institute (NIH/NCATS UL1TR000454); the Emory Global Health Institute; and the Bloomberg Foundation.
• Keywords: Life Sciences & Biomedicine; CESSATION; RISK; CULTURE CONVERSION; Public, Environmental & Occupational Health; Science & Technology; IRON; PREVALENCE; CIGARETTE-SMOKING; INDIA; ASSOCIATION
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Public Health; Health Sciences, Medicine and Surgery

Abstract

Objective: To assess the effect of tobacco smoking on the outcome of tuberculosis treatment in Tbilisi, Georgia. Methods: We conducted a prospective cohort study of adults with laboratory-confirmed tuberculosis from May 2011 to November 2013. History of tobacco smoking was collected using a standardized questionnaire adapted from the global adult tobacco survey. We considered tuberculosis therapy to have a poor outcome if participants defaulted, failed treatment or died. We used multivariable regressions to estimate the risk of a poor treatment outcome. Findings: Of the 591 tuberculosis patients enrolled, 188 (31.8%) were past smokers and 271 (45.9%) were current smokers. Ninety (33.2%) of the current smokers and 24 (18.2%) of the participants who had never smoked had previously been treated for tuberculosis (P < 0.01). Treatment outcome data were available for 524 of the participants, of whom 128 (24.4%) – including 80 (32.9%) of the 243 current smokers and 21 (17.2%) of the 122 individuals who had never smoked – had a poor treatment outcome. Compared with those who had never smoked, current smokers had an increased risk of poor treatment outcome (adjusted relative risk, aRR: 1.70; 95% confidence interval, CI: 1.00–2.90). Those who had ceased smoking more than two months before enrolment did not have such an increased risk (aRR: 1.01; 95% CI: 0.51–1.99). Conclusion: There is a high prevalence of smoking among patients with tuberculosis in Georgia and smoking increases the risk of a poor treatment outcome.