Alcohol use as a risk factor for tuberculosis - a systematic review

Area of Science:

• Epidemiology
• Public Health
• Infectious Diseases

Background:

• A known association exists between alcohol use and tuberculosis (TB) risk.
• The extent of confounding by social and other factors related to alcohol use has not been established.
• The precise strength of the alcohol-TB association requires further clarification.

Purpose of the Study:

• To systematically review existing evidence on the association between alcohol consumption and the risk of developing tuberculosis.
• To quantify the strength of this association and explore potential confounding factors.

Main Methods:

• A systematic literature review identified 3 cohort and 18 case-control studies.
• Studies were categorized by exposure definition, TB type, and controlled confounders.
• Pooled effect sizes were calculated for various study sub-categories.

Main Results:

• The pooled relative risk for TB was 3.50 (95% CI: 2.01-5.93) for alcohol intake ≥40 g/day or alcohol use disorder.
• Excluding small studies due to potential bias reduced the risk to 2.94 (95% CI: 1.89-4.59).
• Subgroup analyses controlling for confounders did not significantly alter results or explain heterogeneity.

Conclusions:

• Individuals consuming over 40g of alcohol daily or having an alcohol use disorder face a substantially elevated risk of active tuberculosis.
• This increased risk may stem from social behaviors linked to alcohol use promoting infection, and alcohol's direct impact on the immune system.