Projected effects of tobacco smoking on worldwide tuberculosis control: mathematical modelling analysis.
Projected effects of tobacco smoking on worldwide tuberculosis control: mathematical modelling analysis.
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DOI：
10.1136/bmj.d5506
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发表时间：
2011-10-04
期刊：
影响因子：
--
通讯作者：
Glantz SA
中科院分区：
文献类型：
--
作者：
Basu S;Stuckler D;Bitton A;Glantz SA
目标全世界几乎有20%的人吸烟，预计在许多贫穷国家这一比例还会上升。吸烟与结核病感染和死亡的个人风险增加有关，但尚不清楚这些风险如何影响全人口的结核病发病率。设计：我们构建了一个结核病流行的状态转换，分区，数学模型来估计未来吸烟趋势对结核病控制的影响。我们预测了2010年至2050年世界卫生组织各区域的结核病发病率、流行率和死亡率，并纳入了吸烟、病例发现、治疗成功率和艾滋病毒流行率的变化趋势。结果该模型预测，如果吸烟趋势继续沿着目前的轨迹发展，2010年至2050年期间，吸烟将导致超过1800万结核病病例（标准误差16-20）和4000万结核病死亡（39-41）。与不考虑吸烟的模型预测相比，吸烟的影响预计将使结核病病例增加7%（2.74亿对2.56亿），死亡人数增加66%（1.01亿对6100万）。吸烟还可能推迟实现千年发展目标中关于从1990年到2015年将结核病死亡率降低一半的具体目标。该模型估计，到2050年，积极的烟草控制（每年将吸烟率降低1%，直至根除）将避免2700万吸烟导致的肺结核死亡。然而，如果成年人的吸烟率增加到50%（正如在烟草使用率高的国家所观察到的那样），该模型估计，到2050年，结核病死亡人数将增加3400万人。吸烟可能在未来几年内大幅增加全球结核病病例和死亡人数，破坏结核病死亡率目标的进展。积极的烟草控制可以避免数百万人死于肺结核。
Objectives Almost 20% of people smoke tobacco worldwide—a percentage projected to rise in many poor countries. Smoking has been linked to increased individual risk of tuberculosis infection and mortality, but it remains unclear how these risks affect population-wide tuberculosis rates. Design We constructed a state transition, compartmental, mathematical model of tuberculosis epidemics to estimate the impact of alternative future smoking trends on tuberculosis control. We projected tuberculosis incidence, prevalence, and mortality in each World Health Organization region from 2010 to 2050, and incorporated changing trends in smoking, case detection, treatment success, and HIV prevalence. Results The model predicted that smoking would produce an excess of 18 million tuberculosis cases (standard error 16-20) and 40 million deaths from tuberculosis (39-41) between 2010 and 2050, if smoking trends continued along current trajectories. The effect of smoking was anticipated to increase the number of tuberculosis cases by 7% (274 million v 256 million) and deaths by 66% (101 million v 61 million), compared with model predictions that did not account for smoking. Smoking was also expected to delay the millennium development goal target to reduce tuberculosis mortality by half from 1990 to 2015. The model estimated that aggressive tobacco control (achieving a 1% decrease in smoking prevalence per year down to eradication) would avert 27 million smoking attributable deaths from tuberculosis by 2050. However, if the prevalence of smoking increased to 50% of adults (as observed in countries with high tobacco use), the model estimated that 34 million additional deaths from tuberculosis would occur by 2050. Conclusions Tobacco smoking could substantially increase tuberculosis cases and deaths worldwide in coming years, undermining progress towards tuberculosis mortality targets. Aggressive tobacco control could avert millions of deaths from tuberculosis.
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影响因子：
15.8
作者：
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DOI：
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发表时间：
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影响因子：
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作者：
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影响因子：
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作者：
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通讯作者：
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