title: A dose-response relationship of smoking with tuberculosis infection: A cross-sectional study among 21008 rural residents in China.
abstract: OBJECTIVE
  China has high burden on both of tuberculosis (TB) and tobacco use. This study aims to explore the potential link between smoking and TB infection using baseline survey data of a large-scale population-based prospective study in rural China.
  
  
  METHODS
  Between July 1 and Sept 30, 2013, based on the baseline survey of a population-based, prospective study in rural China, the relationship between smoking and TB infection, assessed by interferon-gamma release assays (IGRA), was investigated among the total study population and only among those smokers, respectively.
  
  
  RESULTS
  A total of 21,008 eligible rural registered residents (≥ 5 years old) from 4 rural sites were included in the analysis. Ever-smokers were more likely to be QuantiFERON-TB Gold In-Tube (QFT) positive than never smokers with an adjusted odds ratio (OR) of 1.34 (95% confidence interval (CI): 1.21-1.49). Among ever smokers, a significant linear dose-response relation was observed between duration of smoking (by years) and QFT positivity (p < 0.001). Stratified analysis suggested that such an association was not influenced by gender and age. Evidence for interaction of smoking status with age was found.
  
  
  CONCLUSIONS
  Our results provide further evidence to support smoking might increase host susceptibility to TB infection. Populations under high risk of infection, such as elderly smokers, should be prior to TB infection controlling under a premise of community level intervention.
authors.affiliation: MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Centre for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
authors.forename: Haoran
authors.initials: H
authors.lastname: Zhang
authors.affiliation: MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Centre for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
authors.forename: Henan
authors.initials: H
authors.lastname: Xin
authors.affiliation: MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Centre for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
authors.forename: Xiangwei
authors.initials: X
authors.lastname: Li
authors.affiliation: MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Centre for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
authors.forename: Hengjing
authors.initials: H
authors.lastname: Li
authors.affiliation: MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Centre for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
authors.forename: Mufei
authors.initials: M
authors.lastname: Li
authors.affiliation: Jiangsu Provincial Center for Diseases Control and Prevention, Nanjing, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Lu
authors.affiliation: Hunan Provincial Institute of Tuberculosis Prevention and Control, Changsha, China.
authors.forename: Liqiong
authors.initials: L
authors.lastname: Bai
authors.affiliation: Gansu Provincial Center for Diseases Control and Prevention, Lanzhou, China.
authors.forename: Xinhua
authors.initials: X
authors.lastname: Wang
authors.affiliation: The Sixth People's Hospital of Zhengzhou, Zhengzhou, China.
authors.forename: Jianmin
authors.initials: J
authors.lastname: Liu
authors.affiliation: MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Centre for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
authors.forename: Qi
authors.initials: Q
authors.lastname: Jin
authors.affiliation: MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Centre for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
authors.forename: Lei
authors.identifier: http://orcid.org/0000-0002-9957-4527
authors.initials: L
authors.lastname: Gao
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012907:Smoking / Q000453:epidemiology*; D014376:Tuberculosis / Q000453:epidemiology*; D055815:Young Adult