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American Journal of Epidemiology Advance Access published online on November 16, 2009
American Journal of Epidemiology, doi:10.1093/aje/kwp308
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American Journal of Epidemiology © The Author 2009. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

Original Contribution

Smoking and Risk of Tuberculosis Incidence, Mortality, and Recurrence in South Korean Men and Women

Sun Ha Jee, Jonathan E. Golub, Jaeseong Jo, Il Su Park, Heechoul Ohrr* and Jonathan M. Samet

* Correspondence to Dr. Heechoul Ohrr, Department of Preventive Medicine and Public Health, Yonsei University College of Medicine, Seoul, South Korea (e-mail: ohrr{at}yuhs.ac).

Received for publication February 12, 2009. Accepted for publication August 31, 2009.

The authors explored the association of cigarette smoking with tuberculosis incidence, recurrence, and mortality. A 14-year prospective cohort study (1992–2006) was carried out in 1,294,504 South Koreans. Participants were grouped by smoking history, and the authors assessed tuberculosis incidence, mortality, and recurrence risk for each group. Unadjusted and adjusted Cox proportional hazards models were used to investigate the association between smoking history and the 3 outcomes of interest, adjusting for age and alcohol use. Compared with never smokers, current smokers had increased mortality from tuberculosis among both men (adjusted hazard ratio (HR) = 1.6, 95% confidence interval (CI): 1.3, 2.0) and women (HR = 1.6, 95% CI: 1.0, 2.4). Current male smokers had greater risk of incident tuberculosis than former smokers (HR = 1.4, 95% CI: 1.3, 1.5), and risk among current smokers increased with number of cigarettes smoked daily. In females, cigarette smoking was not associated with incident tuberculosis. There was interaction between smoking and sex for incidence (P = 0.00047). The effect of smoking was generally reduced with adjustment for body mass index. Among men, the highest alcohol consumption category (≥100 g/day) was associated with risk of incident tuberculosis (HR = 1.5, 95% CI: 1.3, 1.7). This study provides longitudinal evidence that smoking increases risk of incident tuberculosis, mortality from tuberculosis, and tuberculosis recurrence.

alcohol drinking; incidence; mortality; recurrence; smoking; tuberculosis

Abbreviations: BMI, body mass index


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