Article Text

other Versions

Download PDFPDF
Cigarette smoking and pulmonary tuberculosis in northern California
  1. Geneé S Smith1,
  2. Stephen K Van Den Eeden2,
  3. Roger Baxter2,
  4. Jun Shan2,
  5. Annelies Van Rie1,
  6. Amy H Herring3,4,
  7. David B Richardson1,
  8. Michael Emch1,4,5,
  9. Marilie D Gammon1
  1. 1Departments of Epidemiology, Chapel Hill, North Carolina
  2. 2Division of Research, Kaiser Permanente Northern California, Oakland, California
  3. 3Departments of Biostatistics, Chapel Hill, North Carolina
  4. 4Departments of Carolina Population Center, Chapel Hill, North Carolina
  5. 5Departments of Geography, University of North Carolina, Chapel Hill, North Carolina
  1. Correspondence to Dr Geneé S Smith, Department of Epidemiology, CB# 7435 McGavran-Greenberg Hall, University of North Carolina, Chapel Hill NC 27599-7435, USA; genee{at}


Background A positive association between smoking and increased risk of tuberculosis disease is well documented for populations outside the USA. However, it is unclear whether smoking increases risk of tuberculosis in the USA, where both smoking prevalence and disease rates are much lower than in the countries where previous studies have been conducted.

Methods To explore the tuberculosis–smoking association in a more generalisable US population-based sample, we conducted a nested case–control study among members of Kaiser Permanente Northern California (KPNC). We identified all newly diagnosed cases of active pulmonary tuberculosis (PTB) disease between 1996 and 2010. Each of the 2380 cases were individually matched to two controls by age, gender and race/ethnicity. ORs and 95% CIs for the association between smoking status and PTB were calculated using conditional logistic regression adjusted for all matching factors.

Results Increased PTB risk was observed among ever-smokers (OR=1.35; 95% CI 1.19 to 1.53), as well as current (OR=1.26; 95% CI 1.08 to 1.48) and past (OR=1.43; 95% CI 1.23 to 1.67) smokers, compared with never-smokers. Increased intensity and duration of smoking were also positively associated with PTB risk.

Conclusions Our findings among a more generalisable US population support the hypothesis that smoking increases risk of PTB, underscoring the importance of tobacco cessation and prevention programmes in eliminating tuberculosis.


Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.