RT Journal Article
SR Electronic
T1 Effect of Smoking on Tuberculosis Treatment Outcomes: A Systematic Review and Meta-Analysis
JF Respiratory Care
FD American Association for Respiratory Care
SP 3224433
VO 64
IS Suppl 10
A1 Abay Burusie Adere
YR 2019
UL http://rc.rcjournal.com/content/64/Suppl_10/3224433.abstract
AB Background: Prevalence of tobacco smoking is poorly declining especially in low and middle-income countries. There are numerous studies on effect of cigarette smoking on tuberculosis treatment outcomes but with dissimilar conclusion. Objective: to determine the effect of cigarette smoking on tuberculosis treatment outcomes Methods: PubMed, Cochrane library and Google Scholar databases were searched last on February 27, 2019. Stata version 14 with meta-extension and Comprehensive Meta-analysis (CMA) software were used to analyze the dataset. Random effects model was applied for the analysis and forest plot was displayed together with the effect sizes (odds ratios) and the 95% confidence intervals of the studies. Sub-group analysis and meta-regression were also run to identify reasons for heterogeneity. Publication bias was assessed using funnel plot with superimposed Egger’s regression line and its test of significance. Furthermore, contour enhanced funnel plot, Orwin’s Fail-Safe N, cumulative meta-analysis were performed to check for small study effects. Results: Twenty-two studies were included in the qualitative synthesis. Eight studies reported P -values (< .05) that show smoking significantly increases risk. Four studies also report the same effect albeit they indicated the effect was dependent on dose of the cigarette smoked per day. However, 10 studies reported non-significant P-value (> .05). From the meta-analysis, smoking was found to increase risk of poor tuberculosis treatment outcomes by 51% (OR = 1.51; 95% CI = 1.30 to 1.75 and I-square = 75.1%). The effect is higher for countries with lower-middle income (OR = 1.74; 95% CI = 1.31 to 2.30) and upper-middle income economies (OR = 1.52; 95% CI = 1.16 to 1.98) than for high income ones (OR = 1.34; 95% CI = 1.03 to 1.75) though not statistically significant. The effect of smoking doesn’t show significant improvement over years (P = 0.82). Test of publication bias reported publication bias is unlikely (P = .403) and the Orwin’s Fail-Safe N analysis indicated at least 50 small missing studies are required to bring the computed combined effect to 1.10 trivial odds ratio. The effect of small studies was negligible. Conclusions: Cigarette smoking increases risk of poor tuberculosis treatment outcomes