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PLoS One. 2012;7(7):e39443. doi: 10.1371/journal.pone.0039443. Epub 2012 Jul 27.

Tobacco use or body mass--do they predict tuberculosis mortality in Mumbai, India? Results from a population-based cohort study.

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Healis, Sekhsaria Institute for Public Health, CBD Belapur, India.


Tobacco use and under-nutrition are major public health concerns and tuberculosis is a major cause of morbidity and mortality in India. Using a cohort of 148,173 persons (recruited 1991-1997 and followed-up 1997-2003) the joint effects of tobacco use and BMI on tuberculosis mortality was studied. Tobacco use in any form and low-BMI had joint effect on tuberculosis mortality and the interaction effect was synergistic in men and antagonistic in women. Self-reported tuberculosis was associated with increased risk of tuberculosis mortality. In contrast, no such association was observed for self-reported diabetes persons. The risk pattern remained unchanged even after excluding tuberculosis deaths occurred within 1(st) two years of follow-up. This study highlights importance of age consideration of individual while excluding early deaths. Around 27% male tuberculosis deaths were attributable to their being underweight and smoker, while 22% male and 37% female deaths were attributable to their being underweight and smokeless tobacco user.

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