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Cited by 548Tuberculosis Research and EpidemiologyAlcohol Consumption and Health EffectsSubstance Abuse Treatment and Outcomes

Alcohol use as a risk factor for tuberculosis – a systematic review

Open access
Lönnroth, Knut, Williams, Brian G, Stadlin, Stephanie, Jaramillo, Ernesto, Dye, Christopher·2008·BMC Public Health
DOI 10.1186/1471-2458-8-289PMC PMC2533327
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Abstract

BACKGROUND: It has long been evident that there is an association between alcohol use and risk of tuberculosis. It has not been established to what extent this association is confounded by social and other factors related to alcohol use. Nor has the strength of the association been established. The objective of this study was to systematically review the available evidence on the association between alcohol use and the risk of tuberculosis. METHODS: Based on a systematic literature review, we identified 3 cohort and 18 case control studies. These were further categorized according to definition of exposure, type of tuberculosis used as study outcome, and confounders controlled for. Pooled effect sizes were obtained for each sub-category of studies. RESULTS: The pooled relative risk across all studies that used an exposure cut-off level set at 40 g alcohol per day or above, or defined exposure as a clinical diagnosis of an alcohol use disorder, was 3.50 (95% CI: 2.01-5.93). After exclusion of small studies, because of suspected publication bias, the pooled relative risk was 2.94 (95% CI: 1.89-4.59). Subgroup analyses of studies that had controlled for various sets of confounders did not give significantly different results and did not explain the significant heterogeneity that was found across the studies. CONCLUSION: The risk of active tuberculosis is substantially elevated in people who drink more than 40 g alcohol per day, and/or have an alcohol use disorder. This may be due to both increased risk of infection related to specific social mixing patterns associated with alcohol use, as well as influence on the immune system of alcohol itself and of alcohol related conditions.

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  • For average level of alcohol consumption, there is a dose-response relationship with TB, with some indication that for lower levels of consumption the increase is less steep than for higher levels.

    “Regarding for average level of consumption, there is clearly a dose–response relationship, with some indication that, for lower levels of consumption, the increase is less steep than for higher levels 86, 87.”

    From The relationship between different dimensions of alcohol use and the burden of disease—an update (2017) · cites this paper as [86]

  • People who have had prior contact with mental health services are less likely to receive cardiac catheterisations and coronary artery bypass grafting.

    “For example, people who have had prior contact with mental health services are less likely to receive cardiac catheterisations and coronary artery bypass grafting, which in turn contributes to the higher mortality rates for circulatory disease observed in these populations.[116][117][118]”

    From The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness (2019) · cites this paper as [118]

  • The lower receipt of cardiac procedures contributes to higher mortality rates for circulatory disease in people with prior mental health service contact.

    “which in turn contributes to the higher mortality rates for circulatory disease observed in these populations.[116][117][118]”

    From The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness (2019) · cites this paper as [118]

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Research works printed but not linked: 3

  1. Slama K Association between exposure to tobacco smoke and tuberculosis: A qualitative systematic review (Draft report on WHO/IUATLD joint review) 2007 Paris: International Union Against Tuberculosis and Lung Disease 17945060
  2. Spletter ED Association between active pulmonary tuberculosis, tobacco smoke and alcohol consumption: a case control study (Academic thesis) 2000 Glendale (AZ): Midwestern University
  3. Riekstina V Evaluation of tuberculosis infection and disease treatment and developing evaluation standards for Latvian national tuberculosis programme (Academic thesis) 2005 Riga: Riga Stradins University

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Authors
Lönnroth, K., Williams, B. G., Stadlin, S., Jaramillo, E., & Dye, C.
Affiliations
World Health Organization (CH)
Corresponding author
Lönnroth, Knut
ORCID
Venue
BMC Public Health
Publisher
Springer Science and Business Media LLC
Published
2008-08-14
Volume
8
Issue
1
Pages
289-289
ISSN
1471-2458 (ISSN-L)
DOI
10.1186/1471-2458-8-289
PMC
PMC2533327
OpenAlex
W2169460954
Cited by
548
References
53
Citations by year
2026: 20 · 2025: 28 · 2024: 28 · 2023: 28 · 2022: 47 · 2021: 30 · 2020: 31 · 2019: 32 · 2018: 44 · 2017: 46 · 2016: 42 · 2015: 33 · 2014: 27 · 2013: 38 · 2012: 21
FWCI
2.03
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Public Health (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Medicine › Infectious Diseases › Tuberculosis Research and Epidemiology
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Keywords
alcohol consumption, tuberculosis, alcoholism, risk factors, confounding, immune system, social mixing, publication bias
MeSH terms
Alcohol Drinking, Humans, Risk Factors, Tuberculosis, Cohort Studies, Confidence Intervals, Odds Ratio, Case-Control Studies, Alcohol-Related Disorders

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