Abstract
Background: Tuberculosis (TB) remains a major infectious disease burden in China, where tobacco use is highly prevalent and represents a critical, yet modifiable, risk factor. Smoking is known to impair immune function and may increase susceptibility to Mycobacterium tuberculosis infection and disease progression. This systematic review and meta-analysis aimed to quantify the association between smoking behavior and TB incidence among adults in China to inform integrated TB prevention strategies.
Methods: Researchers systematically searched PubMed, Embase, MEDLINE, Web of Science, PsycINFO, and the Cochrane Library from inception for studies on Chinese populations reporting smoking exposure, TB outcomes, and smoker-non-smoker comparisons. Two reviewers independently screened, extracted data, and assessed bias. Smoking-TB associations were analyzed using random-effects meta-analysis of odds and hazard ratios. The review followed PRISMA and was registered with PROSPERO (CRD420251070123).
Results: Seventeen studies reporting odds ratios and seven studies reporting hazard ratios were included in the quantitative synthesis. The pooled odds ratio for TB incidence among smokers compared with non-smokers was 1.77 (95% CI: 1.29-2.43), indicating a statistically significant increase in risk. For studies reporting hazard ratios, the pooled estimate was 2.39 (95% CI: 1.28-4.45), likewise showing a significant association between smoking and increased TB incidence.
Conclusions: Smoking substantially increases the risk of tuberculosis among adults in China, likely through immune-mediated mechanisms that compromise host defense. These findings highlight the importance of integrating smoking cessation and tobacco control interventions into TB prevention and control programs. Targeting high-risk populations, including heavy smokers in TB-endemic settings, may strengthen TB elimination efforts and improve population-level infectious disease outcomes.
Keywords: Smoking cessation interventions; Tuberculosis; Chinese population; Adults; Smoking behavior; Anti-TB treatment guidelines.