Gajalakshmi Vendhan, Peto Richard
Epidemiological Research Center, Chennai, Tamil Nadu, India.
Int J Epidemiol. 2009 Aug;38(4):1018-25. doi: 10.1093/ije/dyp225. Epub 2009 Jun 4.
To investigate the extent to which smoking and/or drinking can increase the incidence of pulmonary tuberculosis (TB), a population-based case-control study was conducted in rural south India.
A total of 1839 males and 870 females treated in 2000-03 by state TB clinics were interviewed at home in 2004-05 about their education, smoking and drinking habits before disease onset. As controls, 2134 men and 2119 women without TB were randomly chosen from case villages and interviewed. Incidence rate ratios (RRs) are from logistic regression, adjusted for age and education.
No women smoked or drank. The main analyses are of men aged 35-64 years, 949 cases treated for new pulmonary TB and 1963 controls. In the study, 81.5% of the cases and 55.2% of the controls had ever smoked, yielding a standardized ever- vs never-smoker TB incidence RR of 2.7 [95% confidence interval (CI) 2.2-3.3, P < 0.00001). Among control ever-smokers 96% still smoked, 71% used only bidis (mean 17 per day) and 28% used only cigarettes (mean 7 per day). After additional adjustment for alcohol, this RR was 2.2 (95% CI 1.7-2.7, P < 0.00001), but even among those who had never drunk alcohol the standardized ever- vs never-smoker RR was 2.6 (95% CI 2.0-3.6, P < 0.00001). The corresponding RRs for ever- vs never-drinking were somewhat less extreme: 2.2 (95% CI 1.8-2.6, P < 0.00001) without adjustment for smoking, 1.5 (95% CI 1.2-1.9, P = 0.00004) with adjustment for smoking and 2.1 (95% CI 1.4-3.0, 2P = 0.0001) among those who had never smoked. Among control ever-drinkers, 96% still drank and 99% used only spirits (mean 0.3 l/week).
This study of reliably confirmed disease (by the criteria of state TB clinics) demonstrates an increased incidence of pulmonary TB among those who smoke and among those who drink. The effects of smoking after adjustment for drinking were more definite than those of drinking after adjustment for smoking.
为了研究吸烟和/或饮酒会在多大程度上增加肺结核（TB）的发病率，在印度南部农村地区开展了一项基于人群的病例对照研究。
2004 - 2005年，对2000 - 2003年期间在州结核病诊所接受治疗的1839名男性和870名女性进行了家访，询问他们在疾病发作前的教育程度、吸烟和饮酒习惯。作为对照，从病例所在村庄随机选取2134名无结核病的男性和2119名女性进行访谈。发病率比（RRs）来自逻辑回归分析，并对年龄和教育程度进行了调整。
没有女性吸烟或饮酒。主要分析对象为年龄在35 - 64岁的男性，其中949例为新诊断的肺结核患者，1963例为对照。在研究中，81.5%的病例和55.2%的对照曾经吸烟，标准化的曾经吸烟者与从不吸烟者的结核病发病率RR为2.7[95%置信区间（CI）2.2 - 3.3，P < 0.00001]。在对照的曾经吸烟者中，96%仍在吸烟；71%仅吸比迪烟（平均每天17支），28%仅吸卷烟（平均每天7支）。在进一步对饮酒情况进行调整后，该RR为2.2（95%CI 1.7 - 2.7，P < 0.00001），但即使在那些从不饮酒的人群中，标准化的曾经吸烟者与从不吸烟者的RR也为2.6（95%CI 2.0 - 3.6，P < 0.00001）。曾经饮酒者与从不饮酒者的相应RR没有那么极端：未对吸烟情况进行调整时为2.2（95%CI 1.8 - 2.6，P < 0.00001），对吸烟情况进行调整后为1.5（95%CI 1.2 - 1.9，P = 0.00004），在从不吸烟的人群中为2.1（95%CI 1.4 - 3.0，P = 0.0001）。在对照的曾经饮酒者中，96%仍在饮酒，99%仅饮用烈酒（平均每周0.3升）。
这项对经州结核病诊所标准可靠确诊疾病的研究表明，吸烟人群和饮酒人群中肺结核的发病率有所增加。调整饮酒因素后吸烟的影响比调整吸烟因素后饮酒的影响更明确。
