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. 2024 Sep 30;14(1):22653.
doi: 10.1038/s41598-024-72438-4.

The effect of smoking on nontuberculous mycobacterial pulmonary disease and tuberculosis: a nationwide retrospective cohort study

Chiwook Chung  1   2 , Kyu Na Lee  3 , Kyungdo Han  3 , Dong Wook Shin #  4   5 , Sei Won Lee #  6
Affiliations

The effect of smoking on nontuberculous mycobacterial pulmonary disease and tuberculosis: a nationwide retrospective cohort study

Chiwook Chung et al. Sci Rep. .

Abstract

Although smoking is an established risk factor for Mycobacterial infection, the association between smoking and nontuberculous mycobacterial pulmonary disease (NTM-PD) remains unclear. We evaluated the association between smoking and NTM-PD and tuberculosis (TB) using a population-based South Korean nationwide cohort. Using the Korean National Health Insurance Database, we screened individuals over 20 years of age who underwent the national health screening program in 2009. Out of 3,774,308 eligible populations, we identified 2,964 and 26,112 cases of newly developed NTM-PD and TB, respectively. We used multivariate Cox proportional hazards models to estimate the adjusted hazard ratios (aHRs) of risk factors for NTM-PD and TB. The incidence rates for developing NTM-PD and TB were 0.08 and 0.68 per 1,000 person-years, respectively. Current smokers (aHR 0.63, 95% confidence interval [CI] 0.56-0.71) and current heavy smokers (≥ 20 pack-years, aHR 0.74, 95% CI 0.63-0.86) were at lower risk for NTM-PD development than never smokers. On the contrary, current smokers (aHR 1.19, 95% CI 1.15-1.23) and current heavy smokers (aHR 1.27, 95% CI 1.22-1.33) had a higher risk for TB development than never smokers. These trends were augmented if individuals started smoking before age 20 years. In subgroup analyses stratified by age, these trends were prominent in the 40-64 years age range. Current smoking was associated with a decreased risk of NTM-PD and increased risk of TB. These risks were augmented by early smoking initiation and in the middle age population.

Keywords: Age; NTM; Smoking; TB.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The funder did not have any role in the design of the study, in the data collection, analysis, interpretation or in writing the manuscript.

Figures

Fig. 1
Fig. 1
Study flow chart. NTM-PD, nontuberculous mycobacterial pulmonary disease; TB, tuberculosis.
Fig. 2
Fig. 2
Effect of smoking status on NTM and TB development stratified by age. Non-smoker is the reference value. Adjusted hazard ratio is presented with 95% confidence interval. NTM, nontuberculous mycobacteria; TB, tuberculosis.
See this image and copyright information in PMC

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