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A4312 - Influence of Type of Tobacco Product on Chest X-Ray Findings in Pulmonary Tuberculosis Patients in India
Author Block: N. Schenk1, S. Sahu2, G. Roy2, J. J. Ellner3, C. Horsburgh4, V. Kumar5, S. Amsaveni6, J. Pleskunas7, S. Sarkar6, N. Hochberg8, D. Reddy9; 1Boston University School of Public Health, Boston, MA, United States, 2Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education Research, Pondicherry, India, 3Section of Infectious Disease, Boston University School of Medicine, Boston, MA, United States, 4Department of Epidemiology, Boston Univ Sch of Public Hlth, Boston, MA, United States, 5Pulmonary Division, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India, 6Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India, 7Section of Infection Disease, Boston University School of Medicine, Boston, MA, United States, 8Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States, 9Department of Medicine, Pulmonary Division, Albert Einstein College of Medicine, Eastchester, NY, United States.
BACKGROUND: Tobacco smoking (cigarettes and/or bidis) is associated with increased morbidity and mortality in pulmonary tuberculosis (PTB) disease; TB and smoking are widely prevalent in less developed countries. Bidis are unprocessed cigarettes wrapped in tendu or temburni leaves and contain less tobacco but more harmful chemicals (nicotine, ammonia, phenol and hydrogen cyanide). This study aims to assess the influence of the type of tobacco product used on chest x-ray (CXR) findings in PTB patients. METHODS: Data from PTB cases enrolled in the Regional Prospective Observational Research for TB (RePORT) cohort in Puducherry and Tamil Nadu, India were analyzed. At enrollment, standardized questionnaires were used to obtain demographic, socioeconomic, clinical and radiographic information. Smoking was self-reported and defined as ever (current or former) and never smokers. CXRs were obtained prior to initiation of PTB treatment and were read by trained clinicians. Univariate associations were examined using the chi-square, two-sample t-test and analysis of variance test. RESULTS: Among 161 newly diagnosed smear-positive, culture-confirmed PTB cases with CXRs, 119 (73.9%) were male, the median age was 45 years, and 71/161 (44.1%) were ever smokers. Of the 71 smokers, 39 (55.7%) smoked bidis and 23 (32.86%) smoked cigarettes. On univariate analysis, ever smokers were more likely to have bilateral infiltrates (OR=3.7; 95% CI 1.4 - 9.7; p=0.005) and upper zone involvement (OR=3.3; 95% CI 1.2 -9.4; p=0.02) on CXRs compared to never smokers. Further investigation revealed that those who smoked bidis were significantly more likely than never smokers to have bilateral infiltrates on CXR (OR=6.4; 95% CI 1.4 -28.5; p=0.007), but those who smoked cigarettes were not (OR=2.3; 95% CI 0.6 -8.4; p=0.20). Compared to never smokers, those who smoked bidis and those who smoked cigarettes had slightly higher mean percentages of lung with infiltrates on CXR (32% vs 41% and 36% respectively; p=0.09). Bidi smokers were more likely to have cavitations on CXR compared to cigarette smokers, but the results did not reach statistical significance (OR=2.14; 95% CI 0.70 - 6.57; p=0.18). CONCLUSION: Bidis are the preferred form of tobacco among PTB patients in this cohort in southern India. Initial univariate analyses suggest that PTB patients who smoke are more likely to have more severe lung disease on CXR; the effects were particularly notable for bidi smokers. Multivariable analyses are ongoing to control for potential confounders such as socioeconomic status, duration of illness and comorbidities.