Alcohol consumption as a risk factor for tuberculosis: meta-analyses and burden of disease

Abstract

Meta-analyses of alcohol use, alcohol dosage and alcohol-related problems as risk factors for tuberculosis incidence were undertaken. The global alcohol-attributable tuberculosis burden of disease was also re-estimated.Systematic searches were conducted, reference lists were reviewed and expert consultations were held to identify studies. Cohort and case-control studies were included if there were no temporal violations of exposure and outcome. Risk relations (RRs) were pooled by using categorical and dose-response meta-analyses. The alcohol-attributable tuberculosis burden of disease was estimated by using alcohol-attributable fractions.36 of 1108 studies were included. RRs for alcohol use and alcohol-related problems were 1.35 (95% CI 1.09-1.68; I²: 83%) and 3.33 (95% CI 2.14-5.19; 87%), respectively. Concerning alcohol dosage, tuberculosis risk rose as ethanol intake increased, with evidence of a threshold effect. Alcohol consumption caused 22.02 incident cases (95% CI 19.70-40.77) and 2.35 deaths (95% CI 2.05-4.79) per 100 000 people from tuberculosis in 2014. Alcohol-attributable tuberculosis incidence increased between 2000 and 2014 in most high tuberculosis burden countries, whereas mortality decreased.Alcohol consumption was associated with an increased risk of tuberculosis in all meta-analyses. It was consequently a major contributor to the tuberculosis burden of disease.

FIGURE 1

Estimated tuberculosis incidence rates per 100 000 people attributable to alcohol consumption by countries in 2014. The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoeveron the part of the World Health Organization concerning the legal status of any country territory city or area or of its authoritiesor concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border linesfor which there may not yet be full agreement.

FIGURE 2

Estimated tuberculosis mortality rates per 100 000 people attributable to alcohol consumption by countries in 2014. The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country territory city or area or of its authorities or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement.

FIGURE 3

Estimated tuberculosis incidence rates per 100 000 people attributable to alcohol consumption in high-tuberculosis burden countries for 2000 and 2014.

FIGURE 4

Estimated tuberculosis mortality rates per 100 000 people attributable to alcohol consumption in high-tuberculosis burden countries for 2000 and 2014.