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

The DOI matches its Crossref record; 53 of the 54 references it cites were found in a registry or an index, and 1 are not checked yet.

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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Registry

Crossref · 10.1186/1471-2458-8-289

Cites

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Figures

Figure 1 Forest plot of all 21 studies. Bars indicate 95% confidence interval. Filled squares represent point estimate for studies in the high exposure/alcoholism category, white squares represent studies in the low exposure category, and grey circles studies that did not report a well-defined exposure level.
Figure 1 Forest plot of all 21 studies. Bars indicate 95% confidence interval. Filled squares represent point estimate for studies in the high exposure/alcoholism category, white squares represent studies in the low exposure category, and grey circles studies that did not report a well-defined exposure level.CC BY · PubMed Central
Figure 2 Funnel plot of the odds-ratio against the precision of the estimates. Points to the right of the dashed line are significant at the 5% level. The apex of the funnel gives the point estimate. Points outside the funnel differ from the point estimate at the 5% level and suggest heterogeneity in the estimates. If there is no bias in the selection of studies for publication, the points should be evenly scattered to the left and right. Squares represent the three studies with largest standard error that were excluded in the category "Excluding three smallest studies" in table 2 (Mori et al 1992, Spletter 2000, and Riekstina et al 2005). The two filled circles that are outside the funnel represent the two additional studies that were excluded in the category "Excluding three smallest and Brown I and Kim" in table 2
Figure 2 Funnel plot of the odds-ratio against the precision of the estimates. Points to the right of the dashed line are significant at the 5% level. The apex of the funnel gives the point estimate. Points outside the funnel differ from the point estimate at the 5% level and suggest heterogeneity in the estimates. If there is no bias in the selection of studies for publication, the points should be evenly scattered to the left and right. Squares represent the three studies with largest standard error that were excluded in the category "Excluding three smallest studies" in table 2 (Mori et al 1992, Spletter 2000, and Riekstina et al 2005). The two filled circles that are outside the funnel represent the two additional studies that were excluded in the category "Excluding three smallest and Brown I and Kim" in table 2CC BY · PubMed Central

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Citations

Cites

Research works printed but not linked: 5

  1. Pincock TA: Alcoholism in tuberculosis patients. Can Med Assoc J. 1964, 91: 851-4.
  2. 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
  3. Spletter ED: Association between active pulmonary tuberculosis, tobacco smoke and alcohol consumption: a case control study (Academic thesis). 2000, Glendale (AZ): Midwestern University
  4. 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
  5. World Health Organization: Global status report on alcohol 2004. Geneva. 2004

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Metadata

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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