Johns Hopkins University, Baltimore, Maryland, USA; Maine Medical Center, Portland, Maine, USA.
Byramji Jeejeebhoy Medical College (BJMC), Pune, India.
Int J Tuberc Lung Dis. 2014 Feb;18(2):198-204. doi: 10.5588/ijtld.13.0314.
India accounts for the largest burden of tuberculosis (TB) worldwide, with 26% of the world's cases.
To assess the association between novel modifiable risk factors and TB in Indian children.
Cases were children aged ≤ 5 years with confirmed/probable TB based on World Health Organization definitions (definition 1). Controls were healthy children aged ≤ 5 years. Logistic regression was performed to estimate the adjusted odds ratio (aOR) of being a TB case given exposure, including indoor air pollution (IAP; exposure to tobacco smoke and/or biomass fuels) and vitamin D deficiency. Cases were re-analyzed according to a new consensus research definition of pediatric TB (definition 2).
Sixty cases and 118 controls were enrolled. Both groups had high levels of vitamin D deficiency (55% vs. 50%, P = 0.53). In multivariable analysis, TB was associated with household TB exposure (aOR 25.41, 95%CI 7.03-91.81), household food insecurity (aOR 11.55, 95%CI 3.33-40.15) and IAP exposure (aOR 2.67, 95%CI 1.02-6.97), but not vitamin D deficiency (aOR 1.00, 95%CI 0.38-2.66). Use of definition 2 reduced the number of cases to 25. In multivariate analysis, TB exposure, household food insecurity and IAP remained associated with TB.
Household TB exposure, exposure to IAP and household food insecurity were independently associated with pediatric TB.
印度是全球结核病（TB）负担最重的国家，占全球病例的 26%。
评估印度儿童中新出现的可改变危险因素与结核病之间的关联。
病例为年龄≤5 岁且根据世界卫生组织定义确诊/可能患有结核病的儿童（定义 1）。对照组为年龄≤5 岁的健康儿童。采用 logistic 回归分析评估暴露于室内空气污染（IAP；接触烟草烟雾和/或生物质燃料）和维生素 D 缺乏的情况下，成为结核病病例的调整比值比（aOR）。根据儿科结核病的新共识研究定义（定义 2）重新分析病例。
纳入了 60 例病例和 118 例对照。两组的维生素 D 缺乏率均较高（55%对 50%，P=0.53）。多变量分析显示，TB 与家庭 TB 暴露（aOR 25.41，95%CI 7.03-91.81）、家庭食物不安全（aOR 11.55，95%CI 3.33-40.15）和 IAP 暴露（aOR 2.67，95%CI 1.02-6.97）相关，但与维生素 D 缺乏无关（aOR 1.00，95%CI 0.38-2.66）。使用定义 2 后，病例数减少至 25 例。多变量分析显示，TB 暴露、家庭食物不安全和 IAP 仍与 TB 相关。
家庭 TB 暴露、IAP 暴露和家庭食物不安全与儿童结核病独立相关。
