High risk for TB recurrence, mortality during treatment with tobacco use
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Key takeaways:
- A meta-analysis revealed high risks for TB recurrence/relapse and mortality during treatment with tobacco use.
- Tobacco use also raised the risk for all-cause mortality, TB mortality and treatment failure.
Patients with tuberculosis who used tobacco faced a heightened risk for disease recurrence/relapse and death during treatment, according to a systematic review and meta-analysis published in CHEST.
“The results of our review provide additional evidence to invest in ... policies and practices to reduce the global TB and tobacco-related disease burden,” Aishwarya Lakshmi Vidyasagaran, PhD, research associate in the department of health sciences at the University of York, and colleagues wrote.
After searching through three databases up to Nov. 22, 2021, Vidyasagaran and colleagues examined 28 epidemiologic studies of patients with TB in a random effects meta-analysis to determine how tobacco use impacts TB recurrence/relapse and mortality during treatment.
To evaluate the degree of heterogeneity, researchers used the I2 statistic, in which minimal heterogeneity is represented when I2 equals 0% and considerable heterogeneity is represented when I2 is greater than 75%.
The risk for TB recurrence/relapse was reported by 15 studies. With individuals who did not currently use tobacco/never used tobacco as the reference, current tobacco users faced a significant elevated risk for TB recurrence/relapse (RR = 1.95; 95% CI, 1.59-2.4; I2 = 72%; 13 studies), as did ever tobacco users (RR = 1.78; 95% CI, 1.31-2.43; I2 = 85%; five studies) and former tobacco users (RR = 1.84; 95% CI, 1.21-2.8; I2 = 74%; three studies).
Varying quality, design and patient characteristics between the studies caused some heterogeneity in these results, according to researchers.
Similar to the above results, researchers observed a heightened risk for mortality during TB treatment among ever tobacco users (RR = 1.55; 95% CI, 1.32-1.81; I2 = 0%; four studies) vs. never tobacco users and current tobacco users (RR = 1.51; 95% CI, 1.09-2.1; I2 = 87%; nine studies) vs. individuals not currently using tobacco.
Varying study design was behind the heterogeneity observed in the current tobacco use findings.
The certainty of evidence within the analyses on TB recurrence/relapse and mortality during treatment was deemed very low or low according to Grading of Recommendations, Assessment, Development and Evaluation (GRADE) assessments.
In addition to the main findings, tobacco use raised the risk for all-cause mortality (seven of 11 studies), TB mortality (11 studies), treatment failure (nine of 12 studies), delayed sputum conversion (24 of 25 studies), treatment nonadherence (seven of eight studies) and hospitalization/cavitation (five studies) during qualitative synthesis (123 studies).
Lastly, researchers assessed the relationship between smokeless tobacco use and TB outcomes and found that those using this type of tobacco vs. not using it faced a greater risk for worse outcomes, including TB mortality, unsuccessful treatment and treatment nonadherence, in a small number of studies.
“Although evidence is limited on [smokeless tobacco], it still suggests that we need to be cognizant of the risks associated with its use, especially given its disproportionately high prevalence in [low-income and middle-income countries],” Vidyasagaran and colleagues wrote. “The integration of tobacco cessation within TB services offers a viable option, particularly in [low-income and middle-income countries].”