Problem drinking as a risk factor for tuberculosis: a propensity score matched analysis of a national survey

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dc.contributor.authorCois, Annibaleen_ZA
dc.contributor.authorEhrlich, Rodneyen_ZA
dc.date.accessioned2015-11-23T12:10:12Z
dc.date.available2015-11-23T12:10:12Z
dc.date.issued2013en_ZA
dc.description.abstractBACKGROUND:Epidemiological and other evidence strongly supports the hypothesis that problem drinking is causally related to the incidence of active tuberculosis and the worsening of the disease course. The presence of a large number of potential confounders, however, complicates the assessment of the actual size of this causal effect, leaving room for a substantial amount of bias. This study aims to contribute to the understanding of the role of confounding in the observed association between problem drinking and tuberculosis, assessing the effect of the adjustment for a relatively large number of potential confounders on the estimated prevalence odds ratio of tuberculosis among problem drinkers vs. moderate drinkers/abstainers in a cross-sectional, nationally representative sample of the South African adult population. METHODS: A propensity score approach was used to match each problem drinker in the sample with a subset of moderate drinkers/abstainers with similar characteristics in respect to a set of potential confounders. The prevalence odds ratio of tuberculosis between the matched groups was then calculated using conditional logistic regression. Sensitivity analyses were conducted to assess the robustness of the results in respect to misspecification of the model. RESULTS: The prevalence odds ratio of tuberculosis between problem drinkers and moderate drinkers/abstainers was 1.97 (95% CI: 1.40 to 2.77), and the result was robust with respect to the matching procedure as well as to incorrect adjustment for potential mediators and to the possible presence of unmeasured confounders. Sub-population analysis did not provide noteworthy evidence for the presence of interaction between problem drinking and the observed confounders. CONCLUSION: In a cross-sectional national survey of the adult population of a middle income country with high tuberculosis burden, problem drinking was associated with a two fold increase in the odds of past TB diagnosis after controlling for a large number of socio-economic and biological confounders. Within the limitations of a cross-sectional study design with self-reported tuberculosis status, these results adds to previous evidence of a causal link between problem drinking and tuberculosis, and suggest that the observed higher prevalence of tuberculosis among problem drinkers commonly found in population studies cannot be attributed to the confounding effect of the uneven distribution of other risk factors.en_ZA
dc.identifier.apacitationCois, A., & Ehrlich, R. (2013). Problem drinking as a risk factor for tuberculosis: a propensity score matched analysis of a national survey. <i>BMC Public Health</i>, http://hdl.handle.net/11427/15260en_ZA
dc.identifier.chicagocitationCois, Annibale, and Rodney Ehrlich "Problem drinking as a risk factor for tuberculosis: a propensity score matched analysis of a national survey." <i>BMC Public Health</i> (2013) http://hdl.handle.net/11427/15260en_ZA
dc.identifier.citationCois, A., & Ehrlich, R. (2013). Problem drinking as a risk factor for tuberculosis: a propensity score matched analysis of a national survey. BMC public health, 13(1), 871.en_ZA
dc.identifier.ris TY - Journal Article AU - Cois, Annibale AU - Ehrlich, Rodney AB - BACKGROUND:Epidemiological and other evidence strongly supports the hypothesis that problem drinking is causally related to the incidence of active tuberculosis and the worsening of the disease course. The presence of a large number of potential confounders, however, complicates the assessment of the actual size of this causal effect, leaving room for a substantial amount of bias. This study aims to contribute to the understanding of the role of confounding in the observed association between problem drinking and tuberculosis, assessing the effect of the adjustment for a relatively large number of potential confounders on the estimated prevalence odds ratio of tuberculosis among problem drinkers vs. moderate drinkers/abstainers in a cross-sectional, nationally representative sample of the South African adult population. METHODS: A propensity score approach was used to match each problem drinker in the sample with a subset of moderate drinkers/abstainers with similar characteristics in respect to a set of potential confounders. The prevalence odds ratio of tuberculosis between the matched groups was then calculated using conditional logistic regression. Sensitivity analyses were conducted to assess the robustness of the results in respect to misspecification of the model. RESULTS: The prevalence odds ratio of tuberculosis between problem drinkers and moderate drinkers/abstainers was 1.97 (95% CI: 1.40 to 2.77), and the result was robust with respect to the matching procedure as well as to incorrect adjustment for potential mediators and to the possible presence of unmeasured confounders. Sub-population analysis did not provide noteworthy evidence for the presence of interaction between problem drinking and the observed confounders. CONCLUSION: In a cross-sectional national survey of the adult population of a middle income country with high tuberculosis burden, problem drinking was associated with a two fold increase in the odds of past TB diagnosis after controlling for a large number of socio-economic and biological confounders. Within the limitations of a cross-sectional study design with self-reported tuberculosis status, these results adds to previous evidence of a causal link between problem drinking and tuberculosis, and suggest that the observed higher prevalence of tuberculosis among problem drinkers commonly found in population studies cannot be attributed to the confounding effect of the uneven distribution of other risk factors. DA - 2013 DB - OpenUCT DO - 10.1186/1471-2458-13-871 DP - University of Cape Town J1 - BMC Public Health LK - https://open.uct.ac.za PB - University of Cape Town PY - 2013 T1 - Problem drinking as a risk factor for tuberculosis: a propensity score matched analysis of a national survey TI - Problem drinking as a risk factor for tuberculosis: a propensity score matched analysis of a national survey UR - http://hdl.handle.net/11427/15260 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/15260
dc.identifier.urihttp://dx.doi.org/10.1186/1471-2458-13-871
dc.identifier.vancouvercitationCois A, Ehrlich R. Problem drinking as a risk factor for tuberculosis: a propensity score matched analysis of a national survey. BMC Public Health. 2013; http://hdl.handle.net/11427/15260.en_ZA
dc.language.isoengen_ZA
dc.publisherBioMed Central Ltden_ZA
dc.publisher.departmentDepartment of Public Health and Family Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an Open Access article distributed under the terms of the Creative Commons Attribution Licenseen_ZA
dc.rights.holder2013 Cois and Ehrlich; licensee BioMed Central Ltd.en_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/2.0en_ZA
dc.sourceBMC Public Healthen_ZA
dc.source.urihttp://www.biomedcentral.com/bmcpublichealth/en_ZA
dc.subject.otherTuberculosisen_ZA
dc.subject.otherAlcoholen_ZA
dc.subject.otherProblem drinkingen_ZA
dc.subject.otherMultiple confoundersen_ZA
dc.subject.otherPropensity scoreen_ZA
dc.subject.otherSensitivity analysisen_ZA
dc.titleProblem drinking as a risk factor for tuberculosis: a propensity score matched analysis of a national surveyen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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