Li Huiqi, Chee Cynthia B E, Geng Tingting, Pan An, Koh Woon Puay
Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China.
Singapore Tuberculosis Control Unit, Tan Tock Seng Hospital, Singapore.
Clin Infect Dis. 2022 Aug 25;75(2):213-220. doi: 10.1093/cid/ciab935.
Little is known about the joint associations of multiple lifestyle risk factors including smoking, low body mass index, physical inactivity, alcohol consumption, and low diet quality with risk of active tuberculosis.
We analyzed data from the Singapore Chinese Health Study, a prospective cohort study of 63 257 Chinese adults aged 45-74 years enrolled between 1993 and 1998. Incident cases of active tuberculosis were identified via linkage with the National TB Registry through 31 December 2016. Cox proportional hazards regression models were used to compute hazard ratios (HRs) and 95% confidence intervals (CIs) of tuberculosis risk in relation to the combined scores of lifestyle risk factors.
Compared with participants with none of the risk factors, the adjusted HRs (95% CI) of active tuberculosis for participants with 1, 2, 3, 4, and 5 risk factors were 1.24 (1.02-1.51), 1.84 (1.51-2.23), 2.52 (2.03-3.14), 4.07 (3.07-5.41), and 9.04 (5.44-15.02), respectively (Ptrend < .0001). The HR for those with 5 factors was ~1.5 times the product of individual risk estimates from the 5 factors on a multiplicative scale. The stepwise increase in risk of active tuberculosis with increasing number of lifestyle risk factors was significantly stronger in participants with diabetes than their counterparts without diabetes at recruitment (Pinteraction = .01).
Multiple lifestyle risk factors were associated with risk of active tuberculosis in a synergistic manner. Our findings highlight the importance of public health programs and interventions targeting these factors simultaneously to reduce the tuberculosis burden among the general population.
关于吸烟、低体重指数、缺乏身体活动、饮酒和低饮食质量等多种生活方式风险因素与活动性肺结核风险的联合关联，人们了解甚少。
我们分析了新加坡华人健康研究的数据，这是一项对1993年至1998年间招募的63257名45 - 74岁华人成年人进行的前瞻性队列研究。通过与国家结核病登记处的关联，确定截至2016年12月31日的活动性肺结核发病病例。采用Cox比例风险回归模型计算与生活方式风险因素综合得分相关的结核病风险的风险比（HRs）和95%置信区间（CIs）。
与无任何风险因素的参与者相比，有1、2、3、4和5个风险因素的参与者发生活动性肺结核的调整后HRs（95%CI）分别为1.24（1.02 - 1.51）、1.84（1.51 - 2.23）、2.52（2.03 - 3.14）、4.07（3.07 - 5.41）和9.04（5.44 - 15.02）（P趋势<0.0001）。在乘法尺度上，有5个因素的人群的HR约为这5个因素各自风险估计值乘积的1.5倍。在招募时患有糖尿病的参与者中，随着生活方式风险因素数量的增加，活动性肺结核风险的逐步增加明显强于无糖尿病的参与者（P交互作用=0.01）。
多种生活方式风险因素以协同方式与活动性肺结核风险相关。我们的研究结果强调了同时针对这些因素的公共卫生项目和干预措施对于减轻普通人群结核病负担的重要性。
