Alcohol consumption as a risk factor for tuberculosis: meta-analyses and burden of disease
Sameer Imtiaz, Kevin D Shield, Michael Roerecke, Andriy V Samokhvalov, Knut Lönnroth, Jürgen Rehm, Sameer Imtiaz, Kevin D Shield, Michael Roerecke, Andriy V Samokhvalov, Knut Lönnroth, Jürgen Rehm
Abstract
Meta-analyses of alcohol use, alcohol dosage and alcohol-related problems as risk factors for tuberculosis incidence were undertaken. The global alcohol-attributable tuberculosis burden of disease was also re-estimated.Systematic searches were conducted, reference lists were reviewed and expert consultations were held to identify studies. Cohort and case-control studies were included if there were no temporal violations of exposure and outcome. Risk relations (RRs) were pooled by using categorical and dose-response meta-analyses. The alcohol-attributable tuberculosis burden of disease was estimated by using alcohol-attributable fractions.36 of 1108 studies were included. RRs for alcohol use and alcohol-related problems were 1.35 (95% CI 1.09-1.68; I2: 83%) and 3.33 (95% CI 2.14-5.19; 87%), respectively. Concerning alcohol dosage, tuberculosis risk rose as ethanol intake increased, with evidence of a threshold effect. Alcohol consumption caused 22.02 incident cases (95% CI 19.70-40.77) and 2.35 deaths (95% CI 2.05-4.79) per 100 000 people from tuberculosis in 2014. Alcohol-attributable tuberculosis incidence increased between 2000 and 2014 in most high tuberculosis burden countries, whereas mortality decreased.Alcohol consumption was associated with an increased risk of tuberculosis in all meta-analyses. It was consequently a major contributor to the tuberculosis burden of disease.
Conflict of interest statement
Conflict of interest: Disclosures can be found alongside this article at erj.ersjournals.com
Copyright ©ERS 2017.
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References
- World Health Organization. Global Tuberculosis Report. World Health Organization, Geneva, Switzerland, 2016.
- Institute for Health Metrics and Evaluation. GBD Compare. 2015. Date last acessed: July 19, 2016.
- Lönnroth K, Williams B, Stadlin S, et al. . Alcohol use as a risk factor for tuberculosis – a systematic review. BMC Public Health 2008; 8: 289.
- Rehm J, Samokhvalov AV, Neuman MG, et al. . The association between alcohol use, alcohol use disorders and tuberculosis (TB). A systematic review. BMC Public Health 2009; 9: 450.
- Rehm J, Baliunas D, Borges GL, et al. . The relation between different dimensions of alcohol consumption and burden of disease – an overview. Addiction 2010; 105: 817–843.
- Moher D, Liberati A, Tetzlaff J, et al. . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009; 6: e1000097.
- Tocque K, Bellis M, Beeching NJ, et al. . A case-control study of lifestyle risk factors associated with tuberculosis in Liverpool, North-West England. Eur Respir J 2001; 18: 959–964.
- World Health Organization. International Guide for Monitoring Alcohol Consumption and Related Harm. Geneva, World Health Organization, 2000.
- DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986; 7: 177–188.
- Cochran WG. The combination of estimates from different experiments. Biometrics 1954; 10: 101–129.
- Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med 2002; 21: 1539–1558.
- Egger M, Smith GD, Schneider M, et al. . Bias in meta-analysis detected by a simple, graphical test. BMJ 1997; 315: 629–634.
- World Health Organization. Global Tuberculosis Report. Geneva, World Health Organization, 2015.
- World Health Organization. Global Status Report on Alcohol and Health. Geneva, World Health Organization, 2014.
- Orsini NBR, Greenland S. Generalized least squares for trend estimation of summarized dose-response data. Stata J 2006; 6: 40–57.
- Kehoe T, Gmel G Jr, Shield K, et al. . Determining the best population-level alcohol consumption model and its impact on estimates of alcohol-attributable harms. Popul Health Metr 2012; 10: 6.
- Murray CJL, Lopez A. On the comparable quantification of health risks: lessons from the global burden of disease study. Epidemiology 1999; 10: 594–605.
- World Health Organization. Global status report on alcohol. Geneva, World Health Organization, 2004.
- Rehm J, Kehoe T, Gmel G, et al. . Statistical modeling of volume of alcohol exposure for epidemiological studies of population health: the example of the US. Popul Health Metr 2010; 8: 3.
- Gmel GJ, Shield KD, Frick H, et al. . Estimating uncertainty of alcohol-attributable fractions for infectious and chronic diseases. BMC Med Res Methodol 2011; 11: 48.
- World Health Organization. WHO TB burden estimates. 2016. Date last accessed: October 5, 2016.
- Stevens GA, Alkema L, Black RE, et al. . Guidelines for accurate and transparent health estimates reporting: the GATHER statement. Lancet 2016; 388: e19–e23.
- Gajalakshmi V, Peto R. Smoking, drinking and incident tuberculosis in rural India: population-based case-control study. Int J Epidemiol 2009; 38: 1018–1025.
- Jee SH, Golub JE, Jo J, et al. . Smoking and risk of tuberculosis incidence, mortality, and recurrence in South Korean men and women. Am J Epidemiol 2009; 170: 1478–1485.
- Amoakwa K, Martinson NA, Moulton LH, et al. . Risk factors for developing active tuberculosis after the treatment of latent tuberculosis in adults infected with human immunodeficiency virus. Open Forum Infect Dis 2015; 2: ofu120.
- Hemilä H, Kaprio J, Pietinen P, et al. . Vitamin C and other compounds in vitamin C rich foods in relation to risk of tuberculosis in male smokers. Am J Epidemiol 1999; 150: 632–641.
- Rosenman K, Hall N. Occupational risk factors for developing tuberculosis. Am J Ind Med 1996; 30: 148–154.
- Buskin SE, Gale JL, Weiss NS, et al. . Tuberculosis risk factors in adults in King County, Washington, 1988 through 1990. Am J Public Health 1994; 84: 1750–1756.
- Chen M, Deng J, Li W, et al. . Impact of tea drinking upon tuberculosis: a neglected issue. BMC Public Health 2015; 15: 515.
- Kolappan C, Subramani R. Association between biomass fuel and pulmonary tuberculosis: a nested case–control study. Thorax 2009; 64: 705–708.
- Ladefoged K, Rendal T, Skifte T, et al. . Risk factors for tuberculosis in Greenland: case-control study. Int J Tuberc Lung Dis 2011; 15: 44–49.
- Coker R, McKee M, Atun R, et al. . Risk factors for pulmonary tuberculosis in Russia: case-control study. BMJ 2006; 332: 85–87.
- Shetty N, Shemko M, Vaz M, et al. . An epidemiological evaluation of risk factors for tuberculosis in South India: a matched case control study. Int J Tuberc Lung Dis 2006; 10: 80–86.
- Crampin AC, Glynn JR, Floyd S, et al. . Tuberculosis and gender: exploring the patterns in a case control study in Malawi. Int J Tuberc Lung Dis 2004; 8: 194–203.
- Brown KE, Campbell AH. Tobacco, alcohol and tuberculosis. Br J Dis Chest 1961; 55: 150–158.
- Lewis D, Chamberlain J. Alcohol consumption and smoking habits in male patients with pulmonary tuberculosis. Br J Prev Soc Med 1963; 17: 149–152.
- Tekkel M, Rahu M, Loit HM, et al. . Risk factors for pulmonary tuberculosis in Estonia. Int J Tuberc Lung Dis 2002; 6: 887–894.
- Lienhardt C, Fielding K, Sillah JS, et al. . Investigation of the risk factors for tuberculosis: a case-control study in three countries in West Africa. Int J Epidemiol 2005; 34: 914–923.
- Spletter ED. Association between active pulmonary tuberculosis, tobacco smoke and alcohol consumption: a case control study (Academic thesis). Midwestern University, Glendale, USA, 2000.
- Dong B, Zhou Y. Smoking and alcohol consumption as risk factors of pulmonary tuberculosis in Chengdu: a matched case-control study. Hua Xi Yi Ke Da Xue Xue Bao 2001; 32: 104–106.
- Baker MA, Lin HH, Chang HY, et al. . The risk of tuberculosis disease among persons with diabetes mellitus: a prospective cohort study. Clin Infect Dis 2012; 54: 818–825.
- Hill PC, Jackson-Sillah D, Donkor SA, et al. . Risk factors for pulmonary tuberculosis: a clinic-based case control study in The Gambia. BMC Public Health 2006; 6: 156.
- Pokhrel AK, Bates MM, Verma SC, et al. . Tuberculosis and indoor biomass and kerosene use in Nepal: a case-control study. Environ Health Perspect 2010; 118: 558–564.
- Ruffino-Netto A, Caron-Ruffino M. Interação de fatores riscos em tuberculose. Rev Saude Publica 1979; 13: 119–122.
- Souza de Lima D, Morishi Ogusku M, Porto Dos Santos M, et al. . Alleles of HLA-DRB1* 04 Associated with Pulmonary Tuberculosis in Amazon Brazilian Population. PloS One 2016; 11: e0147543.
- Kim S, Crittenden K. Risk factors for tuberculosis among inmates: a retrospective analysis. Public Health Nurs 2005; 22: 108–118.
- Mori MA, Leonardson G, Welty TK. The benefits of isoniazid chemoprophylaxis and risk factors for tuberculosis among Oglala Sioux Indians. Ann Intern Med 1992; 152: 547–550.
- Inghammar M, Löfdahl CG, Winqvist N, et al. . Impaired pulmonary function and the risk of tuberculosis: a population-based cohort study. Eur Respir J 2011; 37: 1285–1287.
- Lin YT, Wu PH, Lin CY, et al. . Cirrhosis as a risk factor for tuberculosis infection – a nationwide longitudinal study in Taiwan. Am J Epidemiol 2014; 180: 103–110.
- Hsu WH, Kuo CH, Wang SS, et al. . Acid suppressive agents and risk of Mycobacterium tuberculosis: case–control study. BMC Gastroenterol 2014; 14: 91.
- Leegaard A, Riis A, Kornum JB, et al. . Diabetes, glycemic control, and risk of tuberculosis: a population-based case-control study. Diabetes Care 2011; 34: 2530–2535.
- Mahuad C, Bozza V, Pezzotto SM, et al. . Impaired immune responses in tuberculosis patients are related to weight loss that coexists with an immunoendocrine imbalance. Neuroimmunomodulation 2007; 14: 193–199.
- Moran-Mendoza O, Marion SA, Elwood K, et al. . Risk factors for developing tuberculosis: a 12-year follow-up of contacts of tuberculosis cases. Int J Tuberc Lung Dis 2010; 14: 1112–1119.
- Inghammar M, Ekbom A, Engström G, et al. . COPD and the risk of tuberculosis-a population-based cohort study. PloS One 2010; 5: e10138.
- Boccia D, Hargreaves J, De Stavola BL, et al. . The association between household socioeconomic position and prevalent tuberculosis in Zambia: a case-control study. PloS One 2011; 6: e20824.
- Oliveira HBD, Moreira Filho DDC. Recidivas em tuberculose e seus fatores de risco. Rev Panam Salud Pública 2000; 74: 232–241.
- Menezes AMB, Costa JDD, Gonçalves H, et al. . Incidência e fatores de risco para tuberculose em Pelotas, uma cidade do Sul do Brasil. Rev Bras Epidemiol 1998; 1: 50–60.
- Rehm J, Anderson P, Gual A, The tangible common denominator of substance use disorders: a reply to commentaries to Rehm et al. (2013). Alcohol Alcohol 2014; 49: 118–122.
- Simet SM, Sisson JH. Alcohol's effects on lung health and immunity. Alcohol Res 2015; 37: 199–208.
- Francisco J, Oliveira O, Felgueiras Ó, et al. . How much is too much alcohol in tuberculosis? Eur Respir J 2016; 49: 1601468.
- Shield K, Samokhvalov A, Rehm J. Global burden of tuberculosis and lower respiratory infections attributable to alcohol consumption in 2004. Int J Alcohol Drug Res 2013; 2: 11–18.
- Forouzanfar MH, Alexander L, Anderson HR, et al. . Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2015; 386: 2287–2323.
- Joshi PC, Applewhite L, Ritzenthaler JD, et al. . Chronic ethanol ingestion in rats decreases granulocyte-macrophage colony-stimulating factor receptor expression and downstream signaling in the alveolar macrophage. J Immunol 2005; 175: 6837–6845.
- Dannenberg AM. Immune mechanisms in the pathogenesis of pulmonary tuberculosis. Rev Infect Dis 1989; 11: S369–S378.
- Castro A, Lefkowitz DL, Lefkowitz SS. Effects of alcohol on murine macrophage function. Life Sci 1993; 52: 1585–1593.
- Dorio RJ, Forman HJ. Ethanol inhibition of signal transduction in superoxide production by rat alveolar macrophages. A proposed mechanism for ethanol related pneumonia. Ann Clin Lab Sci 1988; 18: 190–194.
- Rimland D, Hand WL. The effect of ethanol on adherence and phagocytosis by rabbit alveolar macrophages. J Lab Clin Med 1980; 95: 918–926.
- Rimland K. Mechanisms of ethanol-induced defects of alveolar macrophage function. Alcohol Clin Exp Res 1983; 8: 73–76.
- Bermudez L, Young LS. Ethanol augments intracellular survival of mycobacterium avium complex and impairs macrophage responses to cytokines. J Infect Dis 1991; 163: 1286–1292.
- Crews FT, Bechara R, Brown LA, et al. . Cytokines and alcohol. Alcohol Clin Exp Res 2006; 30: 720–730.
- Gamble L, Mason CM, Nelson S. The effects of alcohol on immunity and bacterial infection in the lung. Med Mal Infect 2006; 36: 72–77.
- Szabo G, Saha B. Alcohol's effect on host defense. Alcohol Res 2015; 37: 159–170.
- Szabo G. Alcohol and susceptibility to tuberculosis. Alcohol Health Res World 1997; 21: 39–41.
- Szabo G. Alcohol's contribution to compromised immunity. Alcohol Health Res World 1997; 21: 30–41.
- Lieber CS. Biochemical and molecular basis of alcohol-induced injury to liver and other tissues. N Engl J Med 1988; 319: 1639–1650.
- Dunne FJ. Alcohol and immune system. A causative agent in altering host defence mechanisms. BMJ 1989; 289: 543–544.
- Diel R, Schneider S, Meywald-Walter K, et al. . Epidemiology of tuberculosis in Hamburg, Germany: long-term population-based analysis applying classical and molecular epidemiological techniques. J Clin Microbiol 2002; 4: 532–539.
- Zolnir-Dovc M, Poljak M, Erzen D, et al. . Molecular epidemiology of tuberculosis in Slovenia: results of a one-year (2001) nation-wide study. Scand J Infect Dis 2003; 35: 863–868.
- Classen CN, Warren R, Richardson M, et al. . Impact of social interactions in the community on the transmission of tuberculosis in a high incidence area. Thorax 1999; 54: 136–140.
- World Health Organization. The End TB Strategy: Global Strategy and Targets for Tuberculosis Prevention, Care and Control After 2015. Geneva, World Health Organization, 2015.
- Lönnroth K, Jaramillo E, Williams BG, et al. . Drivers of tuberculosis epidemics: the role of risk factors and social determinants. Soc Sci Med 2009; 68: 2240–2246.
- Uplekar M, Weil D, Lönnroth K, et al. . WHO's new End TB Strategy. Lancet 2015; 385: 1799–1801.
- Lönnroth K, Castro KG, Chakaya JM, et al. . Tuberculosis control and elimination 2010–50: cure, care, and social development. Lancet 2010; 375: 1814–1829.
- Anderson P, Chisholm D, Fuhr D. Effectiveness and cost-effectiveness of policies and programmes to reduce the harm caused by alcohol. Lancet 2009; 373: 2234–2246.
- World Health Organization. Closing the gap in a generation: health equity through action on the social determinants of health. Commission on Social Determinants of Health Final Report. Geneva, World Health Organization, 2008.
- Lönnroth K, Migliori GB, Abubakar I, et al. . Towards tuberculosis elimination: an action framework for low-incidence countries. Eur Respir J 2015; 45: 928–952.
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