The 13th World Conference on Tobacco OR Health

An association between smoking and tuberculosis is of major public health importance for developing countries but cohort studies from industrialized countries did not provide any substantive information. In recent years several studies have been reported. The cross-sectional studies from India show that the prevalence of self-reported TB and of confirmed disease was about 3 times higher among the ever-smokers compared to the never-smokers. The relative risk of mortality from TB has been reported from case-control and cohort studies as 3 to 4 times higher in ever-smokers compared to never-smokers. A clear dose-response relationship of smoking exposure has been reported for the prevalence of TB as well as for the deaths due to TB. In India, in addition to cigarette relative risks were higher for bidi smoking as well. It is estimated that smoking contributes to half the male deaths from TB in India and a quarter of all male deaths in the middle age (25-69 years). Interesting results have been reported from other countries as well: the risk of multi-drug resistant TB was higher among smokers (Brazil); children exposed to tobacco smoke are more likely to develop tuberculosis (Thailand, Spain, India); smoking lengthens the time to a negative sputum culture (South Africa); and, smoking was associated with higher relapse rate (India). Observations are also published from Australia, Estonia, China, Gambia, Guinea Bissau-+ ,, Hong Kong, Ireland, Nigeria, Pakistan and USA.