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IJE Advance Access published online on June 13, 2008
International Journal of Epidemiology, doi:10.1093/ije/dyn113
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Published by Oxford University Press on behalf of the International Epidemiological Association. © The Author 2008; all rights reserved.
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that: the original authorship is properly and fully attributed; the Journal and Oxford University Press are attributed as the original place of publication with the correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org

Smoking increases the risk of relapse after successful tuberculosis treatment

Joanna d’Arc Lyra Batista1, Maria de Fátima Pessoa Militão de Albuquerque1,2,*, Ricardo Arraes de Alencar Ximenes1,3 and Laura Cunha Rodrigues4

1Universidade Federal de Pernambuco, Recife, Brazil.
2Centro de Pesquisas Aggeu magalhães/FIOCRUZ, Recife, Brazil.
3Universidade de Pernambuco, Recife, Brazil.
4London School of Hygiene and Tropical Medicine, London, UK.

*Corresponding author. Centro de Pesquisas Aggeu Magalhães/FIOCRUZ, Av. Moraes Rego, s/n Campus da Universidade Federal de Pernambuco; Cidade Universitária, Recife PE, CEP: 50670–420, Brazil. E-mail: militao{at}cpqam.fiocruz.br


  Abstract

Background Recent tobacco smoking has been identified as a risk factor for developing tuberculosis, and two studies which have investigated its association with relapse of tuberculosis after completion of treatment had conflicting results (and did not control for confounding). The objective of this study was to investigate risk factors for tuberculosis relapse, with emphasis on smoking.

Methods A cohort of newly diagnosed TB cases was followed up from their discharge after completion of treatment (in 2001–2003) until October 2006 and relapses of tuberculosis ascertained during that period. A case of relapse was defined as a patient who started a second treatment during the follow up.

Results Smoking (OR 2.53, 95% CI 1.23–5.21) and living in an area where the family health program was not implemented (OR 3.61, 95% CI 1.46–8.93) were found to be independently associated with relapse of tuberculosis.

Conclusions Our results establish that smoking is associated with relapse of tuberculosis even after adjustment for the socioeconomic variables. Smoking cessation support should be incorporated in the strategies to improve effectiveness of Tuberculosis Control Programs.

Keywords Tuberculosis control, successful treatment, relapse, risk factors, smoking

Accepted 13 May 2008


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