Prospective study of smoking and tuberculosis in India

Objective. Although tuberculosis has already become uncommon in industrialised countries, is a major burden in many developing countries, including India. This paper examines the association between smoking (mainly bidi smoking) and tuberculosis in Mumbai, India. Method. To study the possible association between smoking and tuberculosis, recruitment of a cohort of 81,443 men ≥ 35 years began in 1991 and was followed up to the end of 2003 in Mumbai. Results. The adjusted risk of tuberculosis deaths among bidi smokers was 2.60 (95% confidence interval (CI): 2.02, 3.33) times higher than never-smokers, with a significant trend for daily frequency of bidi smoking. Also the risk of prevalence of self reported tuberculosis among bidi smokers was 5.23 (95% CI: 4.01, 6.82) times higher than never-smokers. Conclusion. In India around 32% of tuberculosis deaths can be attributable to bidi smoking. Thus, bidi smoking seems to be an important cause of manifestation and death from tuberculosis.