Association of diabetes, smoking, and alcohol use with subclinical-to-symptomatic spectrum of tuberculosis in 16 countries: an individual participant data meta-analysis of national tuberculosis prevalence surveys

dc.contributor.authorHamada, Yohhei
dc.contributor.authorQuartagno, Matteo
dc.contributor.authorLaw, Irwin
dc.contributor.authorMalik, Farihah
dc.contributor.authorBonsu, Frank Adae
dc.contributor.authorAdetifa, Ifedayo M.O.
dc.contributor.authorAdusi-Poku, Yaw
dc.contributor.authorD’Alessandro, Umberto
dc.contributor.authorBashorun, Adedapo Olufemi
dc.contributor.authorBegum, Vikarunnessa
dc.contributor.authorLolong, Dina Bisara
dc.contributor.authorBoldoo, Tsolmon
dc.contributor.authorDlamini, Themba
dc.contributor.authorDonkor, Simon
dc.contributor.authorDwihardiani, Bintari
dc.contributor.authorEgwaga, Saidi
dc.contributor.authorFarid, Muhammad N.
dc.contributor.authorGarfin, Anna Marie Celina G.
dc.contributor.authorGaviola, Donna Mae G.
dc.contributor.authorHusain, Mohammad Mushtuq
dc.contributor.authorIsmail, Farzana
dc.contributor.authorKaggwa, Mugagga
dc.contributor.authorKamara, Deus V.
dc.contributor.authorKasozi, Samuel
dc.contributor.authorKaswaswa, Kruger
dc.contributor.authorKirenga, Bruce
dc.contributor.authorKlinkenberg, Eveline
dc.contributor.authorKondo, Zuweina
dc.contributor.authorLawanson, Adebola
dc.contributor.authorMacheque, David
dc.contributor.authorManhiça, Ivan
dc.contributor.authorMaama-Maime, Llang Bridget
dc.contributor.authorMfinanga, Sayoki
dc.contributor.authorMoyo, Sizulu
dc.contributor.authorMpunga, James
dc.contributor.authorMthiyane, Thuli
dc.contributor.authorMustikawati, Dyah Erti
dc.contributor.authorMvusi, Lindiwe
dc.contributor.authorNguyen, Hoa Binh
dc.contributor.authorNguyen, Hai Viet
dc.contributor.authorPangaribuan, Lamria
dc.contributor.authorPatrobas, Philip
dc.contributor.authorRahman, Mahmudur
dc.contributor.authorRahman, Mahbubur
dc.contributor.authorRahman, Mohammed Sayeedur
dc.contributor.authorRaleting, Thato
dc.contributor.authorRiono, Pandu
dc.contributor.authorRuswa, Nunurai
dc.contributor.authorRutebemberwa, Elizeus
dc.contributor.authorRwabinumi, Mugabe Frank
dc.contributor.authorSenkoro, Mbazi
dc.contributor.authorSharif, Ahmad Raihan
dc.contributor.authorSikhondze, Welile
dc.contributor.authorSismanidis, Charalambos
dc.contributor.authorSovd, Tugsdelger
dc.contributor.authorStavia, Turyahabwe
dc.contributor.authorSultana, Sabera
dc.contributor.authorSuriani, Oster
dc.contributor.authorThomas, Albertina Martha
dc.contributor.authorTobing, Kristina
dc.contributor.authorVan der Walt, Martie
dc.contributor.authorWalusimbi, Simon
dc.contributor.authorZaman, Mohammad Mostafa
dc.contributor.authorFloyd, Katherine
dc.contributor.authorCopas, Andrew
dc.contributor.authorAbubakar, Ibrahim
dc.contributor.authorRangaka, Molebogeng X.
dc.date.accessioned2024-10-09T05:48:07Z
dc.date.available2024-10-09T05:48:07Z
dc.date.issued2023-09
dc.descriptionDATA SHARING STATEMENT : The IPD database is stored within the UCL Data Repository and can be shared subject to the approval of the corresponding authors of the original studies.en_US
dc.description.abstractBACKGROUND Non-communicable diseases (NCDs) and NCD risk factors, such as smoking, increase the risk for tuberculosis (TB). Data are scarce on the risk of prevalent TB associated with these factors in the context of population-wide systematic screening and on the association between NCDs and NCD risk factors with different manifestations of TB, where ∼50% being asymptomatic but bacteriologically positive (subclinical). We did an individual participant data (IPD) meta-analysis of national and sub-national TB prevalence surveys to synthesise the evidence on the risk of symptomatic and subclinical TB in people with NCDs or risk factors, which could help countries to plan screening activities. METHODS In this systematic review and IPD meta-analysis, we identified eligible prevalence surveys in low-income and middle-income countries that reported at least one NCD (e.g., diabetes) or NCD risk factor (e.g., smoking, alcohol use) through the archive maintained by the World Health Organization and by searching in Medline and Embase from January 1, 2000 to August 10, 2021. The search was updated on March 23, 2023. We performed a one-stage meta-analysis using multivariable multinomial models. We estimated the proportion of and the odds ratio for subclinical and symptomatic TB compared to people without TB for current smoking, alcohol use, and selfreported diabetes, adjusted for age and gender. Subclinical TB was defined as microbiologically confirmed TB without symptoms of current cough, fever, night sweats, or weight loss and symptomatic TB with at least one of these symptoms. We assessed heterogeneity using forest plots and I2 statistic. Missing variables were imputed through multi-level multiple imputation. This study is registered with PROSPERO (CRD42021272679). FINDINGS We obtained IPD from 16 national surveys out of 21 national and five sub-national surveys identified (five in Asia and 11 in Africa, N = 740,815). Across surveys, 15.1%–56.7% of TB were subclinical (median: 38.1%). In the multivariable model, current smoking was associated with both subclinical (OR 1.67, 95% CI 1.27–2.40) and symptomatic TB (OR 1.49, 95% CI 1.34–1.66). Self-reported diabetes was associated with symptomatic TB (OR 1.67, 95% CI 1.17–2.40) but not with subclinical TB (OR 0.92, 95% CI 0.55–1.55). For alcohol drinking ≥ twice per week vs no alcohol drinking, the estimates were imprecise (OR 1.59, 95% CI 0.70–3.62) for subclinical TB and OR 1.43, 95% CI 0.59–3.46 for symptomatic TB). For the association between current smoking and symptomatic TB, I2 was high (76.5% (95% CI 62.0–85.4), while the direction of the point estimates was consistent except for three surveys with wide CIs. INTERPRETATION Our findings suggest that current smokers are more likely to have both symptomatic and subclinical TB. These individuals can, therefore, be prioritised for intensified screening, such as the use of chest X-ray in the context of community-based screening. People with self-reported diabetes are also more likely to have symptomatic TB, but the association is unclear for subclinical TB.en_US
dc.description.departmentMedical Microbiologyen_US
dc.description.librarianam2024en_US
dc.description.sdgSDG-03:Good heatlh and well-beingen_US
dc.description.urihttp://www.thelancet.comen_US
dc.identifier.citationHamada, Y., Quartagno, M., Law, I. et al. 2023, 'Association of diabetes, smoking, and alcohol use with subclinical-to-symptomatic spectrum of tuberculosis in 16 countries: an individual participant data meta-analysis of national tuberculosis prevalence surveys', eClinicalMedicine, vol. 63, art. 102191, pp. 1-13. https:/DOI.org/10.1016/j.eclinm.2023.102191.en_US
dc.identifier.other2589-5370
dc.identifier.other10.1016/j.eclinm.2023.102191
dc.identifier.urihttp://hdl.handle.net/2263/98547
dc.language.isoenen_US
dc.publisherElsevieren_US
dc.rights© 2023 The Authors. This is an open access article under the CC BY license.en_US
dc.subjectSmokingen_US
dc.subjectTobaccoen_US
dc.subjectScreeningen_US
dc.subjectNon-communicable diseases (NCDs)en_US
dc.subjectTuberculosis (TB)en_US
dc.subjectDiabetes mellitusen_US
dc.subjectSDG-03: Good health and well-beingen_US
dc.titleAssociation of diabetes, smoking, and alcohol use with subclinical-to-symptomatic spectrum of tuberculosis in 16 countries: an individual participant data meta-analysis of national tuberculosis prevalence surveysen_US
dc.typeArticleen_US

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