Alcohol consumption and risk of tuberculosis: a systematic review and meta-analysis

Objective To perform a systematic review and meta-analysis of the association between alcohol consumption and risk of tuberculosis (TB). Methods Medline, EMBASE and Web of Science were searched for observational studies from 2005 to April 2018. Reference lists of included studies were screened. Results Forty-nine studies were included. Compared with people with low or no alcohol intake, the risk of TB in people with high or any alcohol consumption was increased by relative odds of 1.90 (95%CI 1.63-2.23). Substantial levels of heterogeneity were seen ( I ² = 82%); however, there was no evidence of publication bias ( P = 0.54). Sensitivity analysis restricted to studies using no alcohol drinking as a reference group found a slightly lower but still increased risk (OR 1.60, 95%CI 1.39-1.84). Subgroup analyses revealed no significant differences in relation to study design and quality, geographic location, publication year or adjustment for confounders. A pooled analysis of a further four studies reporting hazard ratios (HRs) found a nearly three-fold increase in risk of TB in relation to alcohol consumption during follow-up (HR 2.81, 95%CI 2.12-3.74). An exposure-response analysis showed that for every 10-20 g daily alcohol intake, there was a 12% increase in TB risk. Conclusion Alcohol consumption is an important risk factor for the development of TB.