Tuberculosis and Risk of Emphysema among US Adults in the NHANES I Epidemiologic Follow-Up Study Cohort, 1971–1992
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. Identification of Emphysema Cases at Baseline for Exclusion
- An explicit presumptive diagnosis of emphysema on chest X-ray readings;
- Possible evidence of emphysema with chest X-ray findings combined with spirometry results not suggestive of restrictive lung disease;
- An obstructive pattern on spirometry with self-reported chronic bronchitis/emphysema;
- All self-reported cases who reported that they still have the condition, when the report could be corroborated with a chest X-ray.
2.3. Identification of Past or Current Tuberculosis at Baseline
2.4. Other Covariates Measured at Baseline
2.5. Identification of Incident Cases
2.6. Analytical Methods
3. Results
4. Discussion
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
Rule-based decision mapping for emphysema combining information from chest X-ray findings, spirometry results, and self-reporting to determine if the individual subjects had emphysema at the time of study initiation. |
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The subject was flagged as having emphysema—ruled out if they reported as never having been diagnosed with emphysema. |
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Vital Status (1992) | (Year of Follow-Up and “Last Known Alive”) | |||||
---|---|---|---|---|---|---|
1982–1984 | 1986 | 1987 | 1992 | Inapplicable * | Total | |
Alive | 47 | 5 | 356 | 7926 | 0 | 8334 |
Dead | 1758 | 557 | 496 | 1244 | 0 | 4055 |
Unknown | 0 | 0 | 0 | 0 | 519 | 519 |
Traced—directly | 5 | 1 | 2 | 237 | 0 | 245 |
Traced—indirectly | 0 | 0 | 124 | 63 | 0 | 187 |
Total | 1810 | 563 | 978 | 9470 | 519 | 13,340 |
Year of Diagnosis ¥ | Incident Cases of Emphysema |
---|---|
1973–1975 | 4 |
1977–1981 | 8 |
1982 | 160 |
1983 | 775 |
1984 | 20 |
1985–1987 | 13 |
1988–1992 | 14 |
Total incident cases | 994 |
Characteristics | Individuals Who Developed Emphysema (n = 994) | Individuals Who Did Not Develop Emphysema (n =12,346) | p Value | ||
---|---|---|---|---|---|
% | 95% CI | % | 95% CI | ||
Race | <0.001 | ||||
Whites | 94.3% | 92.4, 96.2 | 88.5% | 86.8, 90.1 | |
African American | 5.4% | 3.5, 7.3 | 10.2% | 8.6, 11.8 | |
Other | 0.3% | 0.0, 0.8 | 1.3% | 0.9, 1.7 | |
Gender | 0.74 | ||||
Females | 52.4% | 47.2, 57.6 | 53.3% | 51.8, 54.9 | |
Male | 47.6% | 42.4, 52.8 | 46.7% | 45.1, 48.2 | |
Age group (age in yearsat time of enrollment) | <0.001 | ||||
25–34 | 17.9% | 13.8, 22.0 | 29.1% | 27.8, 30.4 | |
35–44 | 16.6% | 13.5, 19.8 | 21.8% | 20.6, 22.9 | |
45–54 | 23.7% | 20.4, 27.1 | 21.9% | 20.9, 22.9 | |
55–64 | 26.2% | 22.2, 30.2 | 16.4% | 15.4, 17.5 | |
≥65 | 15.5% | 11.8, 19.2 | 10.8% | 10.2, 11.4 | |
Urban versus rural | 0.93 | ||||
Urban | 68.3% | 63.6, 72.9 | 68.5% | 64.9, 72.1 | |
Rural | 31.7% | 27.1, 36.4 | 31.5% | 27.9, 35.1 | |
Region | 0.83 | ||||
Northeast | 26.3% | 19.4, 33.3 | 24.2% | 21.3, 26.9 | |
Midwest | 24.4% | 19.4, 29.5 | 25.5% | 22.2, 28.9 | |
South | 24.0% | 19.6, 28.5 | 23.7% | 19.4, 27.9 | |
West | 25.2% | 20.1, 30.4 | 26.6% | 22.3, 30.9 | |
Type of living quarters | 0.63 | ||||
Living in housing units | 99.3% | 98.2, 100.0 | 99.5% | 99.2, 99.7 | |
Other units | 0.7% | 0.0, 1.8 | 0.5% | 0.33, 0.76 | |
Individuals living in house with a range or cookstove b | 0.02 | ||||
Yes | 99.7% | 99.4, 100.0 | 99.1% | 98.8, 99.4 | |
Number of people per room per household b | <0.0001 | ||||
1 | 93.5% | 91.5, 95.4 | 91.3% | 90.2, 92.5 | |
2 | 6.0% | 4.0, 8.0 | 8.4% | 7.3, 9.5 | |
3 | 0.5% | 0.0, 1.2 | 0.2% | 0.1, 0.4 | |
4–5 | 0.1% | 0.0, 0.2 | 0.0% | 0.0, 0.0 | |
Family income (in dollars) c,d | <0.0001 | ||||
Less than $5000 | 21.2% | 17.5, 24.8 | 17.5% | 16.0, 18.9 | |
$5000–$10,000 | 33.1% | 29.1, 37.1 | 26.6% | 24.9, 28.3 | |
$10,000–$24,999 | 40.2% | 35.4, 45.0 | 45.3% | 43.3, 47.4 | |
$25,000 and over | 3.1% | 1.8, 4.4 | 6.9% | 5.9, 7.9 | |
Missing | 2.4% | 1.1, 3.8 | 3.8% | 3.2, 4.4 | |
Educational attainment | <0.0001 | ||||
High school or less | 66.5% | 61.9, 70.9 | 54.1% | 51.4, 56.8 | |
At least a year college | 33.1% | 28.6, 37.6 | 45.1% | 42.4, 47.8 | |
Missing | 0.4% | 0.0, 0.8 | 0.8% | 0.5, 1.0 | |
Physical activity (recreational or otherwise) | 0.01 | ||||
Very active | 44.4% | 40.0, 48.7 | 49.1% | 47.5, 50.6 | |
Moderately active | 46.5% | 42.2, 50.8 | 43.7% | 42.2, 45.1 | |
Quite inactive | 9.2% | 6.1, 12.3 | 7.2% | 6.3, 8.0 | |
Missing | 0.0% | 0.0, 0.0 | 0.1% | 0.0, 0.2 | |
Have or had tuberculosis | 0.42 | ||||
Yes | 3.6% | 1.9, 5.2 | 2.9% | 2.2, 3.7 | |
Lifetime smoking (smoked at least 100 or more) d | <0.0001 | ||||
Yes | 77.6% | 73.7, 81.4 | 59.8% | 58.2, 61.2 | |
Frequency of alcohol consumption e | 0.03 | ||||
Everyday/Just about… | 16.8% | 13.1, 20.6 | 15.9% | 14.5, 17.3 | |
About 2–3 times a week | 12.1% | 9.4, 14.8 | 14.3% | 13.2, 15.3 | |
About 1–4 times a month | 23.9% | 19.7, 28.2 | 26.6% | 25.2. 28.1 | |
≥3 but <12 times a year | 10.3% | 7.7, 12.8 | 9.4% | 8.6, 10.1 | |
≤2 or 3 times a year | 12.7% | 9.9, 15.6 | 11.3% | 10.4, 12.1 | |
Do not drink | 23.1% | 19.3, 27.0 | 22.4% | 20.3, 24.5 | |
Missing | 0.0% | 0.0, 2.5 | 0.2% | 0.1, 0.3 | |
BMI f | 0.03 | ||||
Low (<18.5) | 37.4% | 29.7, 45.2 | 31.9% | 25.2, 38.5 | |
Normal (18.5–<25) | 25.9% | 21.4, 30.4 | 31.6% | 28.0, 35.1 | |
Overweight (25–<30) | 23.8% | 18.5, 29.2 | 25.0% | 22.5, 27.5 | |
Obese (>=30) | 12.8% | 9.8, 15.9 | 11.6% | 10.1, 13.2 | |
Mean | SE | Mean | SE | p value | |
Age at initial interview, in years | 52.8 | 0.5 | 47.9 | 0.1 | <0.0001 |
People in household (number) | 3.1 | 1.8 | 3.6 | 1.9 | <0.0001 |
Years since TB diagnosis g | 13.2 | 2.8 | 7.9 | 0.7 | 0.07 |
Characteristics | Adjusted Hazard Ratio | 95% Confidence Interval |
---|---|---|
Have or had tuberculosis | ||
Yes | 0.46 | 0.35, 0.61 |
No | 1 | Reference |
Gender | ||
Female | 1.19 | 1.11, 1.28 |
Male | 1 | Reference |
Age group (in years) | ||
25–34 | 1 | Reference |
35–44 | 0.94 | 0.86, 1.02 |
45–54 | 0.89 | 0.82, 0.97 |
55–64 | 0.95 | 0.85, 1.06 |
≥65 | 1.17 | 1.00, 1.36 |
Family income (in dollars) | ||
Less than $5000 | 0.72 | 0.61, 0.83 |
$5000–$10,000 | 0.69 | 0.59, 0.80 |
$10,000–$24,999 | 0.81 | 0.71, 0.94 |
$25,000 and over | 1 | Reference |
Lifetime smoking (smoked at least 100 or more) | ||
Yes | 1.12 | 1.05, 1.20 |
No | 1 | Reference |
Frequency of alcohol consumption b | ||
Frequent drinkers | 0.93 | 0.81, 1.06 |
Moderate/Rare drinkers | 0.90 | 0.79, 1.02 |
Never drinkers | 1 | Reference |
BMI category c | ||
Low BMI (<18.5) | 0.44 | 0.38, 0.51 |
Normal BMI | 1 | Reference |
Overweight/Obese (≥25) | 1.11 | 1.02, 1.21 |
Exposure Group (As Defined) | n | Cases of Emphysema during Follow-up | Unadjusted HR (95% CL) |
---|---|---|---|
Have or had TB (includes self-reported and/or LTBI, individuals with positive TST at baseline) | 492 | 37 | 0.51 (0.44, 0.60) |
Self-reported TB only | 175 | 24 | 0.86 (0.61, 1.21) ¥ |
LTBI only | 325 | 15 | 0.43 (0.26, 0.73) € |
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Joshi, A.; Su, L.J.; Orloff, M.S. Tuberculosis and Risk of Emphysema among US Adults in the NHANES I Epidemiologic Follow-Up Study Cohort, 1971–1992. Epidemiologia 2023, 4, 525-537. https://doi.org/10.3390/epidemiologia4040044
Joshi A, Su LJ, Orloff MS. Tuberculosis and Risk of Emphysema among US Adults in the NHANES I Epidemiologic Follow-Up Study Cohort, 1971–1992. Epidemiologia. 2023; 4(4):525-537. https://doi.org/10.3390/epidemiologia4040044
Chicago/Turabian StyleJoshi, Anita, L. Joseph Su, and Mohammed S. Orloff. 2023. "Tuberculosis and Risk of Emphysema among US Adults in the NHANES I Epidemiologic Follow-Up Study Cohort, 1971–1992" Epidemiologia 4, no. 4: 525-537. https://doi.org/10.3390/epidemiologia4040044