SynthesisPloS one2014
Tobacco smoking, alcohol drinking, diabetes, low body mass index and the risk of self-reported symptoms of active tuberculosis: individual participant data (IPD) meta-analyses of 72,684 individuals in 14 high tuberculosis burden countries.
Synthesis in PloS one, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 34 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
34 citing papers in PubMed, 2 syntheses or guidelines pooled it, 76 citations in OpenAlex.
- The relationship between different dimensions of alcohol use and the burden of disease-an update.Addiction (Abingdon, England) · 2017Pooled it
- Exposure to second-hand smoke and the risk of tuberculosis in children and adults: a systematic review and meta-analysis of 18 observational studies.PLoS medicine · 2015Pooled it
- Long-Term Trends and Determinants of Tuberculosis Burden in China, 1990-2023: Insights from the Global Burden of Disease Study 2023.Pathogens (Basel, Switzerland) · 2026Article
- Environmental-demographic determinants associated with tuberculosis prevalence in seven African countries: an aggregated dataset analysis.EClinicalMedicine · 2026Article
- Article
- Latent Tuberculosis Infection among Household Contacts of Drug-sensitive Pulmonary Tuberculosis Patients: A Cross-sectional Study from Medan, Indonesia.Acta medica Philippina · 2025Article
- B cells in perivascular and peribronchiolar granuloma-associated lymphoid tissue and B-cell signatures identify asymptomaticInfection and immunity · 2024Article
- Alcohol consumption during pregnancy: the result of a risky consumption trajectory?Cadernos de saude publica · 2023Article
- Joint Associations of Multiple Lifestyle Factors With Risk of Active Tuberculosis in the Population: The Singapore Chinese Health Study.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2022Article
- Tuberculosis Predictive Index for Type 2 Diabetes Mellitus Patients Based on Biological, Social, Housing Environment, and Psychological Well-Being Factors.Healthcare (Basel, Switzerland) · 2022Article
- Metformin as a potential protective therapy against tuberculosis in patients with diabetes mellitus: A retrospective cohort study in a single teaching hospital.Journal of diabetes investigation · 2021Article
- Tuberculosis and Non-Communicable Disease Multimorbidity: An Analysis of the World Health Survey in 48 Low- and Middle-Income Countries.International journal of environmental research and public health · 2021Article
- Impacts of ambient air pollution on glucose metabolism in Korean adults: a Korea National Health and Nutrition Examination Survey study.Environmental health : a global access science source · 2020Article
- More Than Malnutrition: A Review of the Relationship Between Food Insecurity and Tuberculosis.Open forum infectious diseases · 2019Review
- The joint impact of smoking plus alcohol drinking on treatment of pulmonary tuberculosis.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2019Article
- Asthma, Sinonasal Disease, and the Risk of Active Tuberculosis.The journal of allergy and clinical immunology. In practice · 2019Article
- Prevalence and risk factors of active pulmonary tuberculosis among elderly people in China: a population based cross-sectional study.Infectious diseases of poverty · 2019Article
- Smoking, alcohol use disorder and tuberculosis treatment outcomes: A dual co-morbidity burden that cannot be ignored.PloS one · 2019Article
- Diabetes screen during tuberculosis contact investigations highlights opportunity for new diabetes diagnosis and reveals metabolic differences between ethnic groups.Tuberculosis (Edinburgh, Scotland) · 2018Article
- Prevalence of Pulmonary Tuberculosis and Associated Factors Among HIV Positive Patients Attending Antiretroviral Therapy Clinic at Arba Minch General Hospital, Southern Ethiopia.The open microbiology journal · 2018Article
Corrections and comments
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Authors and funding
4 authors at 4 institutions in 1 country.
Funding
Abstract
backgroundThe effects of multiple exposures on active tuberculosis (TB) are largely undetermined. We sought to establish a dose-response relationship for smoking, drinking, and body mass index (BMI) and to investigate the independent and joint effects of these and diabetes on the risk of self-reported symptoms of active TB disease. METHODS AND
findingsWe analyzed 14 national studies in 14 high TB-burden countries using self-reports of blood in cough/phlegm and cough lasting > = 3 weeks in the last year as the measures of symptoms of active TB. The random effect estimates of the relative risks (RR) between active TB and smoking, drinking, diabetes, and BMI<18.5 kg/m2 were reported for each gender. Floating absolute risks were used to examine dyads of exposure. Adjusted for age and education, the risks of active TB were significantly associated with diabetes and BMI<18.5 kg/m2 in both sexes, with ever drinking in men and with ever smoking in women. Stronger dose-response relationships were seen in women than in men for smoking amount, smoking duration and drinking amount but BMI<18.5 kg/m2 showed a stronger dose-response relationship in men. In men, the risks from joint exposures were statistically significant for diabetics with BMI<18.5 kg/m2 (RR = 6.4), diabetics who smoked (RR = 3.8), and diabetics who drank alcohol (RR = 3.2). The risks from joint risk factors were generally larger in women than in men, with statistically significant risks for diabetics with BMI<18.5 kg/m2 (RR = 10.0), diabetics who smoked (RR = 5.4) and women with BMI<18.5 kg/m2 who smoked (RR = 5.0). These risk factors account for 61% of male and 34% of female estimated TB incidents in these 14 countries.
conclusionsTobacco, alcohol, diabetes, and low BMI are significant individual risk factors but in combination are associated with triple or quadruple the risk of development of recent active TB. These risk factors might help to explain the wide variation in TB across countries.
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Registered trials
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