title: Tuberculosis, Airway Obstruction and Mortality in a Finnish Population.
abstract: There is little long-term follow-up data concerning the association between past pulmonary tuberculosis (TB), airway obstruction and mortality. We aimed to analyse a national health examination survey data from 6701 adult Finns undergoing spirometry between 1978 and 1980 (follow-up through 2013). We identified TB either through a disease history or by a TB-indicative scar on a chest x-ray. We specified obstruction using the lower limit of normal (LLN) and classified severity using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages 1-4. After adjusting for smoking and other confounders, past TB associated with obstruction. Compared to non-TB patients, the adjusted odds ratio (OR; 95% CI) of obstruction reached 2.21 (1.52-3.21) among patients with a scar recorded by one radiologist, 2.48 (1.63-3.78) when recorded by both radiologists and 4.59 (2.86-7.37) among patients with a disease history. Among those with neither past TB nor obstruction, with past TB only, with an obstruction only and with both, we found hazard ratios (HRs; 95% CIs) for subsequent mortality of 1.00 (reference), 1.11 (1.03-1.20), 1.62 (1.31-2.00) and 1.77 (1.45-2.16), adjusted for age, gender, smoking, body mass index (BMI), physical activity, education and general health. In conclusion, past TB strongly determines obstruction, although on its own quite weakly predicts premature death. TB and obstruction combined predict an additive mortality pattern.
authors.affiliation: a Helsinki University Hospital , Department of Pulmonary Diseases , Helsinki , Finland.|b University of Helsinki Doctoral Programme in Clinical Research , Helsinki , Finland.|c National Institute for Health and Welfare , Helsinki , Finland.
authors.forename: Tiina
authors.initials: T
authors.lastname: Mattila
authors.affiliation: d Department of Health , National Institute for Health and Welfare , Helsinki , Finland.
authors.forename: Markku
authors.initials: M
authors.lastname: Heliövaara
authors.affiliation: d Department of Health , National Institute for Health and Welfare , Helsinki , Finland.
authors.forename: Harri
authors.initials: H
authors.lastname: Rissanen
authors.affiliation: d Department of Health , National Institute for Health and Welfare , Helsinki , Finland.
authors.forename: Paul
authors.initials: P
authors.lastname: Knekt
authors.affiliation: d Department of Health , National Institute for Health and Welfare , Helsinki , Finland.
authors.forename: Pauli
authors.initials: P
authors.lastname: Puukka
authors.affiliation: e University of Turku , Turku , Finland.|f Finnish Lung Health Association (FILHA) , Helsinki , Finland.
authors.forename: Tuula
authors.initials: T
authors.lastname: Vasankari
mesh_terms: D000328:Adult; D000368:Aged; D000402:Airway Obstruction / Q000000981:diagnostic imaging / Q000453:epidemiology*; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D016017:Odds Ratio; D013902:Radiography, Thoracic; D012720:Severity of Illness Index; D013147:Spirometry; D014397:Tuberculosis, Pulmonary / Q000000981:diagnostic imaging / Q000453:epidemiology*
keywords: Death rate; GOLD stages 1–4; epidemiology; follow-up study; mass chest x-ray