The Impact of Alcohol Drinking And Tobacco Smoking On The Drug-Resistance of Newly Diagnosed Tuberculosis

Background: Finding out more predictors of drug-resistant tuberculosis (DR-TB) helps to facilitate TB prevention and control. Previous study had revealed that tobacco smoking and alcohol drinking might be a risk factor for developing drug-resistant tuberculosis. However, few discussed their joint impact on resistance among newly diagnosed TB cases. This study aimed to assess and compare the joint and independent effect of smoking and drinking on TB resistance.Methods: This was a retrospective study of 7996 newly diagnosed TB patients who were collected from Shandong, China from Jan 1, 2004, to Dec 31, 2020, and all had drug susceptibility results, information about smoking and alcohol consumption. Patients were classified into four groups including smoker only(G1), drinker only(G2), smoker+drinker(G3), non-smoker+non-drinker group(G0). We described the drug-resistant profiles, clinical factors and also calculated the ORs of different drug-resistance among G1, G2, G3, compared to G0.Results:Of 7996 TB cases enrolled, the proportions of G1, G2, G3, and G0 were 8.25%, 3.89%, 16.46%, 71.40%, respectively. The rates of DR-TB, mono-resistant (MR)-TB, multidrug resistant (MDR)-TB, polydrug resistant (PDR)-TB in G1, G2, G3 and G0 were 19.24%/16.4%/17.33%/19.08%, 11.52%/8.68%/10.94%/11.63%, 3.03%/2.57%/2.96%/3.66%, 4.7%/4.82%/3.34%/4.08%, respectively. G3 had a higher risk of MDR1: isoniazid+rifampin (adjusted odds ratio (aOR)=1.913, 95% confidence interval(CI): 1.036-3.532), but had a lower risk of DR-TB (aOR=0.839, 95%CI: 0.712-0.988), rifampin-related resistance (aOR=0.675, 95%CI: 0.492-0.925), streptomycin-related resistance (aOR=0.819, 95%CI: 0.675-0.993), EMB-related resistance (aOR=0.571, 95%CI: 0.342-0.954), MDR3: isoniazid+rifampin+streptomycin (aOR=0.406, 95%CI: 0.194-0.851, any isoniazid+streptomycin resistance (aOR=0.845, 95%CI: 0.714-1). However, there were no significant differences between G1 and G0, G2 and G0 in all drug-resistant sub-types. Those who with cavity had a higher risk of DR-TB among G3 (OR=1.354, 95%CI:1.011-1.814).Conclusions: Although we did not found a independent impact of alcohol drinking or tobacco smoking on TB drug-resistance respectively, these two habits had a joint effect on TB drug-resistance. We should be alert for the emergence of isoniazid+rifampin resistance among populations with both smoking and drinking habits.