Is Tobacco Use Associated With Risk of Recurrence and Mortality Among People With TB?: A Systematic Review and...

Area of Science:

• Public Health
• Epidemiology
• Infectious Diseases

Background:

• Tobacco use is linked to poor tuberculosis (TB) treatment outcomes, but evidence on specific outcomes like relapse and mortality, and smokeless tobacco (ST) use, is not systematically summarized.
• This study systematically reviewed and meta-analyzed the association between tobacco use and TB treatment outcomes.

Approach:

• A systematic literature search was conducted on November 22, 2021, across MEDLINE, Embase, and CINAHL.
• Epidemiologic studies reporting associations between tobacco use and TB treatment outcomes were included.
• Random effects meta-analyses were performed for TB recurrence/relapse and mortality during treatment, with narrative synthesis for other outcomes.

Key Points:

• Meta-analyses of 28 studies found that ever tobacco use (RR 1.78) and current tobacco use (RR 1.95) significantly increased the risk of TB recurrence or relapse.
• Ever tobacco use (RR 1.55) and current tobacco use (RR 1.51) also significantly increased the risk of mortality during TB treatment.
• Narrative synthesis indicated tobacco use is a risk factor for other unfavorable TB outcomes, with limited evidence suggesting increased risk from smokeless tobacco (ST).

Conclusions:

• Tobacco use is a significant risk factor for increased TB recurrence/relapse and mortality during treatment.
• These findings underscore the critical need to integrate tobacco cessation interventions into TB care to improve patient outcomes.
• Further research is needed to fully understand the impact of smokeless tobacco on TB treatment outcomes.