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Link to original content: http://www.ncbi.nlm.nih.gov/pubmed/21972295
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. 2011 Oct 4:343:d5506.
doi: 10.1136/bmj.d5506.

Projected effects of tobacco smoking on worldwide tuberculosis control: mathematical modelling analysis

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Projected effects of tobacco smoking on worldwide tuberculosis control: mathematical modelling analysis

Sanjay Basu et al. BMJ. .

Abstract

Objectives: Almost 20% of people smoke tobacco worldwide--a percentage projected to rise in many poor countries. Smoking has been linked to increased individual risk of tuberculosis infection and mortality, but it remains unclear how these risks affect population-wide tuberculosis rates.

Design: We constructed a state transition, compartmental, mathematical model of tuberculosis epidemics to estimate the impact of alternative future smoking trends on tuberculosis control. We projected tuberculosis incidence, prevalence, and mortality in each World Health Organization region from 2010 to 2050, and incorporated changing trends in smoking, case detection, treatment success, and HIV prevalence.

Results: The model predicted that smoking would produce an excess of 18 million tuberculosis cases (standard error 16-20) and 40 million deaths from tuberculosis (39-41) between 2010 and 2050, if smoking trends continued along current trajectories. The effect of smoking was anticipated to increase the number of tuberculosis cases by 7% (274 million v 256 million) and deaths by 66% (101 million v 61 million), compared with model predictions that did not account for smoking. Smoking was also expected to delay the millennium development goal target to reduce tuberculosis mortality by half from 1990 to 2015. The model estimated that aggressive tobacco control (achieving a 1% decrease in smoking prevalence per year down to eradication) would avert 27 million smoking attributable deaths from tuberculosis by 2050. However, if the prevalence of smoking increased to 50% of adults (as observed in countries with high tobacco use), the model estimated that 34 million additional deaths from tuberculosis would occur by 2050.

Conclusions: Tobacco smoking could substantially increase tuberculosis cases and deaths worldwide in coming years, undermining progress towards tuberculosis mortality targets. Aggressive tobacco control could avert millions of deaths from tuberculosis.

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Conflict of interest statement

Conflicts of interest: All authors have completed the Unified Competing Interest form at http://www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: SB is supported partly by the US Centers for Disease Control and Prevention (R36-CI000607-01) and the National Institutes of Health (T32-GM07205-32); no financial relationships with any organisations that might have an interest in the submitted work in the previous three years, no other relationships or activities that could appear to have influenced the submitted work.

Figures

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Fig 1 Mathematical model of tuberculosis infection, pathogenesis, and mortality. Model calculates the population prevalence of smoking and of HIV in each year of the simulation, and then calculates how the number of new tuberculosis cases and deaths are affected by the increased risk of infection or death posed by each risk factor. Model also incorporates rates of reinfection, case detection, and treatment success, as well as non-tuberculosis mortality, and tuberculosis mortality (web appendix)
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Fig 2 Effect of smoking on tuberculosis incidence in WHO regions
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Fig 3 Effect of smoking on tuberculosis mortality in WHO regions. Arrow=millennium development goal to reduce tuberculosis mortality and prevalence by half by 2015
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Fig 4 Effect of smoking on tuberculosis prevalence statistics. Arrow=millennium development goal to reduce tuberculosis mortality and prevalence by half by 2015

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