pISSN 1907-3062 | eISSN 2407-2230 | Universa Medicina content is searchable on DOAJ, Google Scholar, and OAI

Smoking habit as a risk factor in tuberculosis: a case-control study

Edhyana Sahiratmadja, Nico Nagelkerke
Submission date: Tuesday, 23 February 2016
Published date: Friday, 23 December 2011
DOI: http://dx.doi.org/10.18051/UnivMed.2011.v30.189-196

Article Metrics

Abstract viewed: 351 times


Indonesia is fifth in the tuberculosis (TB) prevalence globally and this country is one of the largest tobacco producers. Smoking has been reported to be an important risk factor for TB and a reduction in smoking could be expected to have a significant impact on TB incidence and prevalence. However, studies from various countries yielded conflicting results. Our study aims to explore the association between smoking and TB in Indonesia as TB-endemic country. In two major cities of Indonesia, Jakarta and Bandung, a case-control study had been conducted. TB was diagnosed based on WHO criteria including clinical presentation, and chest X-ray (CXR) examination, and confirmed by microscopic detection of acid-fast bacilli in Ziehl-Nielsen stained sputum smears or by culture of M. tuberculosis. Newly diagnosed smear-positive pulmonary TB patients (n=802) and their spouses (n=253) or sex-matched neighborhood controls (n=534) were interviewed about their smoking habits. An extensive questionnaire was used to collect data about smoking habits of both patients and controls. Smoking categories were grouped into ever (for current/past smokers) and never. Our study result showed that smoking appears not to be strongly associated with TB (OR=0.99, 95% CI 0.76-1.31). The reasons for the effect heterogeneity remain to be elucidated as smoking is a lethal habit and should be well controlled. The need to incorporate tobacco cessation programs into TB treatment is strongly recommended to improve TB control.


Smoking; tuberculosis; aged >15 years

Full Text:



Frieden TR, Sterling TR, Munsiff SS, Watt CJ, Dye C. Tuberculosis. Lancet 2003;362:887-99.

Lönnroth K, Raviglione M. Global epidemiology of tuberculosis: prospects for control. Semin Respir Crit Care Med 2008;29:481-91.

World Health Organization. Global tuberculosis control: surveillance, planning, financing. WHO report 2005. WHO/HTM/TB/2005.349. World Health Organization, Geneva 2005.

Lienhardt C, Fielding K, Sillah JS, Bah B, Gustafson P, Warndorff D, et al. Investigation of the risk factors for tuberculosis: a case-control study in three countries in West Africa. Int J Epidemiol 2005;34:914-23.

Maurya V, Vijayan VK, Shah A. Smoking and tuberculosis: an association overlooked. Int J Tuberc Lung Dis 2002;6:942-51.

Watkins RE, Plant AJ. Does smoking explain sex differences in the global tuberculosis epidemic? Epidemiol Infect 2006;134:333-9.

Davies PD, Yew WW, Ganguly D, Davidow AL, Reichman LB, Dheda K, et al. Smoking and tuberculosis: the epidemiological association and immunopathogenesis. Trans R Soc Trop Med Hyg 2006;100:291-8.

Kolappan C, Gopi PG. Tobacco smoking and pulmonary tuberculosis. Thorax 2002;57:964-6.

Gajalakshmi V, Peto R, Kanaka TS, Jha P. Smoking and mortality from tuberculosis and other diseases in India: retrospective study of 43000 adult male deaths and 35000 controls. Lancet 2003;362:507-15.

Leung CC, Li T, Lam TH, Yew WW, Law WS, Tam CM, et al. Smoking and tuberculosis among the elderly in Hong Kong. Am J Respir Crit Care Med 2004;170:1027-33.

Ariyothai N, Podhipak A, Akarasewi P, Tornee S, Smithtikarn S, Thongprathum P. Cigarette smoking and its relation to pulmonary tuberculosis in adults. Southeast Asian J Trop Med Public Health 2004;35:219-27.

Sitas F, Urban M, Bradshaw D, Kielkowski D, Bah S, Peto R. Tobacco attributable deaths in South Africa. Tob Control 2004;13:396-9.

Anderson, Johnson C, Palmer PH, Chou CP, Pang Z, Zhou D, et al. Tobacco use among youth and adults in Mainland China: the China Seven Cities Study. Public Health 2006;120:1156-69.

Crampin AC, Glynn JR, Floyd S, Malema SS, Mwinuka VK, Ngwira BM, et al. Tuberculosis and gender: exploring the patterns in a case control study in Malawi. Int J Tuberc Lung Dis 2004;8:194-203.

Leung CC, Lam TH, Ho KS, Yew WW, Tam CM, Chan WM, et al. Passive smoking and tuberculosis. Arch Intern Med 2010;170:287-92.

Alisjahbana B, van Crevel R, Sahiratmadja E, den Heijer M, Maya A, Istriana E, et al. Diabetes mellitus is strongly associated with tuberculosis in Indonesia. Int J Tuberc Lung Dis 2006;10:606-700.

Aditama TY. Kretek. The 13th World Conference on Tobacco OR Health Building capacity for a tobacco-free world. July 12-15, 2006, Washington, DC, USA Available at: http://2006.confex.com/uicc/wctoh/techprogram/MEETING.HTM. Accessed July 1, 2011.

Siddiqi K, Lee AC. An integrated approach to treat tobacco addiction in countries with high tuberculosis incidence.Trop Med Int Health 2009;14:420-8.

Ng N, Padmawati RS, Prabandari YS, Nichter M. Smoking behavior among former tuberculosis patients in Indonesia: intervention is needed. Int J Tuberc Lung Dis 2008;2:567-72.

Boelaert JR, Gomes MS, Gordeuk VR. Smoking, iron, and tuberculosis. Lancet 2003;362:1243-4.

Raghavenra H, Diwakr BT, Lokesh BR, Naidu KA. Eugenol the active principle from cloves inhibits 5-lipoxygenase activity and leukotriene-C4 in human PMNL cells. Prostaglandins Leukot Essent Fatty Acids 2006;74:23-7.

Gajalakshmi V, Peto R. Smoking, drinking and incident tuberculosis in rural India: population-based case-control study. Int J Epidemiol 2009; 38:1018-25.

Wolf R, Freedman D. Cigarette smoking, sexually transmitted diseases, and HIV/AIDS. Int J Dermatol 2000;39:1-9.

Almeida OP, Hulse GK, Lawrence D, Flicker L. Smoking as a risk factor for Alzheimer’s disease: contrasting evidence from a systematic review of case-control and cohort studies. Addiction 2002; 97:15-28.

Hill AB. The environment and disease: association or causation? Proc R Soc Med 1965; 58:295-300.

Arcavi L, Benowitz NL. Cigarette smoking and infection. Arch Intern Med 2004;164:2206-16.

Sopori M. Effects of cigarette smoke on the immune system. Nat Rev Immunol 2002;2:372-7.

Jiang J, Liu B, Nasca PC, Zeng X, Chen J, Zou X, et al. Smoking and risk of death due to pulmonary tuberculosis: a case-control comparison in 103 population centers in China. Int J Tuberc Lung Dis 2009;13:1530-5.

Shang S, Ordway D, Henao-Tamayo M, Bai X, Oberley-Deegan R, Shanley C, et al. Cigarette smoke increases susceptibility to tuberculosis-evidence from in vivo and in vitro models. J Infect Dis 2011;203:1240-8.


  • There are currently no refbacks.

Copyright (c) 2016 Edhyana Sahiratmadja, Nico Nagelkerke

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Creative Commons License
Universa Medicina by Faculty of Medicine, Trisakti University is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Based on a work at https://univmed.org/ejurnal/index.php/medicina/