title: Tuberculosis, smoking and risk for lung cancer incidence and mortality.
abstract: Among the exposures associated with risk for lung cancer, a history of tuberculosis (TB) is one potentially important factor, given the high prevalence of TB worldwide. A prospective cohort study was conducted to evaluate the associations of preexisting pulmonary TB with lung cancer incidence and mortality. The cohort consisted of 1,607,710 Korean adults covered by the National Health Insurance System who had a biennial national medical examination during 1997-2000. During up to 16 years of follow-up, there were 12,819 incident cases of lung cancer and 9,562 lung cancer deaths. Using Cox proportional hazards models and controlling for age, cigarette smoking and other covariates, the presence of underlying TB was significantly associated with increased risk for lung cancer incidence (HR 1.37 in men with 95% CI 1.29-1.45; HR 1.49 in women with 95% CI 1.28-1.74) and mortality (HR 1.43 in men with 95% CI 1.34-1.52; HR 1.53 in women with 95% CI 1.28-1.83). We also observed a dose-response relationship between number of cigarettes smoked daily and lung cancer risk. There was no evidence for synergism between a history of TB and smoking. The elevation in risk is relatively modest, particularly in comparison to that from smoking, and a prior history of TB is not likely to be useful risk indicator for clinical purposes. In populations with high prevalence of TB, it can be considered for incorporation into models for lung cancer risk prediction.
authors: Department of Public Health, Yonsei University Graduate School, Seoul, Republic of Korea.|Department of Epidemiology and Health Promotion, Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea.
authors: Seri
authors: S
authors: Hong
authors: Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.|Department of Epidemiology and Health Promotion, Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea.
authors: Yejin
authors: Y
authors: Mok
authors: Department of Public Health, Yonsei University Graduate School, Seoul, Republic of Korea.|Department of Epidemiology and Health Promotion, Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea.
authors: Christina
authors: C
authors: Jeon
authors: Department of Epidemiology and Health Promotion, Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea. jsunha@yuhs.ac.
authors: Sun Ha
authors: SH
authors: Jee
authors: Department of Preventive Medicine, Keck School of Medicine, Institute for Global Health, University of Southern California, Los Angeles, CA.
authors: Jonathan M
authors: JM
authors: Samet
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D056910:Republic of Korea / Q000453:epidemiology; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology* / Q000401:mortality; D014376:Tuberculosis / Q000453:epidemiology* / Q000401:mortality
keywords: cohort study; effect modifier; lung cancer; smoking; tuberculosis