Smokers at Greater Risk for Tuberculosis

Tobacco smoking was responsible for 100 million deaths in the 20th century, mostly in developed countries. At current rates, it is estimated that smoking will kill about one billion people in the 21st century, mostly in developing countries.

A group of researchers from Harvard School of Public Health have found that smokers have double the risk of tuberculosis, when compared to non-smokers. They also found evidence of an association between smoking, passive smoking and indoor air pollution and tuberculosis infection, disease and mortality.

An associate professor of international health at Harvard School of Public Health, Majid Ezzati said, “Our findings suggest that information on people’s exposure to respirable pollutants from sources such as smoking and biomass use will help TB detection efforts. Additionally, TB control programs may benefit from including interventions aimed at reducing tobacco and IAP exposure, especially among those at high risk for exposure to infection.”

This is a worldwide problem. For instance, in India smoking triples the risk of death from tuberculosis and may even contribute to the spread of TB to others. “Since tobacco smoking has increased in developing countries where TB is prevalent, a considerable portion of the global burden of TB may be attributed to tobacco. Importantly, this also implies that smoking cessation might provide benefits for global TB control in addition to those for chronic diseases,” said Ezzati.

Cessation is the only cure, here in the U.S. and around the world. Most smokers become addicted as adolescents or young adults. By the time child smokers become adults, more than 80% wish they had never started. People who quit in their thirties have death risks close to life-long non-smokers, and even those who stop smoking in their forties have a marked decrease in their risk of death.

But how do we do that? Developed countries already have many tools in place to encourage people to quit, or better yet, to never begin smoking. Distribution of information about the health risks of smoking, smoking bans in public, bans on the advertising and promotion of tobacco products, cessation therapies, and tobacco tax increases are all effective methods in helping smokers quit.

Tax increases are probably the single most cost-effective intervention. As seen in New York, a tripling of the excise tax would roughly double the price of cigarettes, preventing approximately three million deaths per year by 2030.Tax hikes lower consumption and raise revenue. Money not spent on tobacco would be spent on other goods and services.

However, these effective tobacco control measures are not being implemented in developing countries. For instance, in Toronto taxes are about 80% of the street price of cigarettes, but in Delhi or Beijing it is less than 30%. Also, the knowledge of health risks associated with smoking is low. In 1996, 61% of Chinese smokers thought tobacco did ‘little or no harm’. It is estimated that about one million people per year, as well as 150 million young adults, will soon die from smoking in China and India alone, unless there is widespread cessation.

Of course there is opposition to tobacco control from the tobacco industry as well as from the general public who feel that government should not interfere with individual decisions.

It is estimated that within 25 years, tobacco smoking will cause ten million deaths a year worldwide; more than malaria, maternal deaths, childhood infections and diarrhea combined. However, there are signs for hope: more than 160 countries have signed the World Health Organization’s global tobacco control treaty, and Caribbean heads of state have declared they want to tackle tobacco together.

According to Pabhat Jha, a professor of health and development at the University of Toronto and director of the Centre for Global Health Research, between 150 and 180 million deaths would be avoided before 2050 if the proportion of adults in developing countries who quit smoking, increases from today’s level of below five percent to 30-40% by 2020. Because control policies deter children from starting, even greater benefits can be expected beyond 2050.