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Open Access Highly Accessed Research article

The reduction of tuberculosis risks by smoking cessation

Chi-Pang Wen1*, Ta-Chien Chan2, Hui-Ting Chan1, Min-Kuang Tsai1, Ting-Yuang Cheng3 and Shan-Pou Tsai4

Author Affiliations

1 Division of Health Policy Research, Institute of Population Health Science, National Health Research Institutes, Zhunan, Taiwan

2 Graduate Institute of Epidemiology, School of Public Health, National Taiwan University, Taiwan

3 Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA

4 University of Texas School of Public Health, Houston, Texas, USA

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BMC Infectious Diseases 2010, 10:156  doi:10.1186/1471-2334-10-156

Published: 7 June 2010



Smoking is known to aggravate tuberculosis (TB), but such information has been ignored in clinical practice, as it was not thought to be relevant. The aim of this study is to assess the benefits of smoking cessation on TB mortality reduction.


The study attempts to quantify smokers' risks on subsequent TB mortality and the change in such risks after smokers quit smoking. In this prospective cohort study, the TB mortality risks of smokers, never smokers and former smokers were compared, by using the Cox proportional model to estimate the hazard ratio (HR) of TB.

The cohort, consisting of 486,341 adults, participated in standard medical screening programs since 1994, including 5,036 with self-reported TB history. Of 15,268 deaths identified as of 2007, 77 were coded as TB.


Smokers with self-reported TB history (1.2%) had very high TB mortality (HR = 44.02). Among those without self-reported TB history, smoking increased TB mortality by nine-fold (HR = 8.56), but when they quit smoking, the risk was reduced by more than half (65%), to a level not different from those who had never smoked. The overwhelming majority of TB deaths (83%) occurred among those without self-reported TB history. Given the high smoking prevalence and the high HR, smoking accounted for more than one-third (37.7%) of TB mortality in Taiwan. Smokers reported less TB history but died more from TB than those who had never smoked.


Smokers had very high TB mortality, as much as nine times those who had never smoked, but once they quit, the risk reduced substantially and was similar to those who never smoked. Smoking cessation has benefits to the smokers far beyond reducing TB risk, but successful tobacco control could favorably impact the TB mortality rate and reduce this public health burden, which has long haunted the Taiwanese population. Smoking cessation could reduce nearly one-third of tuberculosis deaths.