Department of Health Economy and Management, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.
Students Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran.
Adv Respir Med. 2020;88(5):383-388. doi: 10.5603/ARM.a2020.0138.
Treatment failure in tuberculosis (defined as a positive sputum smear 5 months after the initiation of anti-TB treat-ment) is a major threat to the control over TB. This study aimed to investigate the association of smoking and drug abuse with treatment failure among individuals with TB.
Out of 286 TB patients with available data registered by the health system of Hamadan Provinces in western Iran, 24 TB patients with treatment failure (positive sputum smear, 5 months after initiation of anti-TB treatment) and 262 patients without treatment failure (negative sputum smear, five months after initiation of anti-TB treatment) were selected as case and control groups, respectively. These two groups were compared to each other in terms of demographic status which include age, sex, job, residence, and risk factors such as smoking and drug abuse status. An odds ratio (OR) with a 95% confidence interval was used as a measure of association. The Bonferroni correction was used to counteract multiple comparisons, therefore, a p-value of less than 0.004 was statistically significant.
No significant association was found between treatment failure and age, residence, comorbidity, education level, job status, sex, smoking, and method of drug abuse (P > 0.004). However, a significant association was found between duration of smoking, number of cigarettes per day, and drug abuse with treatment failure in univariate analysis (P < 0.004). In multivariate analysis, only an association with drug abuse was significantly associated with treatment failure (P = 0.047).
Drug abuse substantially increases the risk of treatment failure. Therefore, in order to control TB, it is suggested that preventive programs are designed in order to decrease drug abuse among TB patients before starting treatment.
结核病（定义为抗结核治疗开始后 5 个月痰涂片阳性）治疗失败是结核病控制的主要威胁。本研究旨在调查吸烟和药物滥用与结核病患者治疗失败的关系。
从伊朗西部哈马丹省卫生系统登记的 286 例结核病患者中，选择 24 例治疗失败（抗结核治疗开始后 5 个月痰涂片阳性）和 262 例无治疗失败（抗结核治疗开始后 5 个月痰涂片阴性）的结核病患者作为病例组和对照组，分别比较两组的人口统计学特征，包括年龄、性别、职业、居住地以及吸烟和药物滥用状况等危险因素。使用比值比（OR）及其 95%置信区间作为关联的衡量指标。使用 Bonferroni 校正来抵消多重比较，因此，p 值小于 0.004 具有统计学意义。
治疗失败与年龄、居住地、合并症、教育程度、职业状况、性别、吸烟和药物滥用方式之间无显著关联（P > 0.004）。然而，在单因素分析中，吸烟持续时间、每天吸烟量和药物滥用与治疗失败之间存在显著关联（P < 0.004）。在多因素分析中，只有药物滥用与治疗失败显著相关（P = 0.047）。
药物滥用显著增加了治疗失败的风险。因此，为了控制结核病，建议在开始治疗之前，设计预防计划以减少结核病患者中的药物滥用。
