A case control study of risk factors associated with pulmonary tuberculosis in Romania: Experience at a clinical hospital of pneumology

Abstract

Background and aimTuberculosis (TB) remains a major public health issue in Romania. The aim of the present study was to evaluate the potential demographic, socioeconomic and behavioral risk factors for TB among hospitalized patients in Romania.MethodsThis is a case-control study conducted between March 1st 2014 and March 30th 2015 at Leon Daniello Clinical Hospital of Pneumology, Cluj Napoca. A total of 150 TB patients defined as “cases” were matched for age, sex and county of residence to 150 controls selected from patients attending the same hospital with respiratory diseases other than TB. Data collection was obtained through patient interviews using a structured questionnaire. Factors potentially associated with TB infection were analyzed using univariate and multivariate logistic regression.ResultsFactors independently associated with TB were illiteracy (OR=2.42, 95% CI 1.09–5.37), unemployment (OR=2.08, 95% CI 1.23–3.53), low household income (OR=4.12, 95% CI 2.53–6.71), smoking (more than 20 cigarettes per day) (OR=2.12, 95% CI 1.20–3.74), poor knowledge of TB (OR=3.46, 95% CI 1.97–6.07), presence of TB patient in household (OR=4.35, 95% CI 1.42–13.36), prior TB treatment (OR=2.2, 95% CI 1.93–2.5) and diabetes (OR=3.32, 95% CI 1.36–8.08).ConclusionThis study provided useful information that might help to develop and adapt effective policies for TB control in Romania.

Tuberculosis and tobacco: is there any epidemiological association?

“…Additionally, previous studies showed a statistically significant trend in the risk of TB with increasing number of CPD [10,11]. However, to the best of our knowledge, there is only one previous work that has focused on the threshold number of cigarettes, indicating that smoking more than 20 CPD was an independent factor associated with TB [12]. We found a significantly higher risk of TB for men smoking 20 or more CPD in comparison with nonsmoking individuals, but no significant difference between the latter and those smoking up to 20 CPD.…”

Risk of active tuberculosis among people with diabetes mellitus: systematic review and meta‐analysis

“…After reading the full text, 57 studies were excluded for various reasons mentioned in Figure . Thus, 14 studies (eight cohort studies and six case‐control studies), published between 1992 and 2017, which involved 22 616 623 participants, met the eligibility criteria for this analysis .…”

“…Median follow‐up time in the cohort studies ranged from one to five years. Of the six case‐control studies, one (Denmark) was nationwide and one (Romania) was hospital‐based . All studies had adjusted the rate ratio or odds ratio at least for age, and some studies had adjusted for a variety of potential confounders, such as gender, ethnicity, body mass index (BMI), or socio‐economic status.…”

“…Differential misclassification of outcome (TB) might have occurred if doctors were more likely to screen DM patients for active TB. Selection bias would have occurred in studies that included only pulmonary TB (PTB) patients . These studies might overestimate the effect of DM on TB risk since current findings consistently showed DM patients are more likely to develop PTB than extra‐pulmonary TB compared to non‐DM populations .…”

“…This may partly explain the result of meta‐regression grouped by TB type: PTB group had a higher effect estimate (RR;3.63) than All‐TB group (RR;2.08). Five studies relied exclusively on self‐report for the diagnosis of DM , which could result in differential misclassification of exposure either by under‐reporting or under‐diagnosis of DM. A previous review reported that nearly half of adult DM patients globally were undiagnosed .…”