INT J TUBERC LUNG DIS 10(1):80–86

© 2006 The Union

An epidemiological evaluation of risk factors for

tuberculosis in South India: a matched case control study

N. Shetty,* M. Shemko,* M. Vaz,† G. D’Souza‡

*Department of Clinical Microbiology, Health Protection Agency Collaborating Centre, University College
London Hospitals, London, United Kingdom; † Institute of Population Health and Clinical Research, and ‡
Department of Medicine, St John’s National Academy of Health Sciences, Bangalore, India
SUMMARY

S E T T I N G : There are limited data on risk factors
associ-ated with tuberculosis (TB) in India.
O B J E C T I V E S : To evaluate potential socio-
demographic risk factors for TB.
D E S I G N : Matched case-control. Cases were all new di-
agnoses of pulmonary TB attending as out-patients at St
John’s Medical College Hospital, Bangalore, India,
from October 2001 to October 2003. Age- and sex-
matched controls, one for each case (n 189), were
recruited among relatives accompanying non-TB in-
patients in the hospital.
R E S U L T S : Significant risk factors were low education
level (OR 0.30; 95%CI 0.11–0.82), not having a sepa-
rate kitchen (OR 3.26; 95%CI 1.25–8.46) and chronic
disease, mainly diabetes (OR 2.44; 95%CI 1.17–5.09).
High income, cooking with biomass fuels, history of
smoking and alcohol consumption were not significant
on multivariate analysis. Patients were respectively 11
and seven times more likely to have a BMI 18.5 (95%CI
5.62–21.98) and mid-arm circumference 24 cm (95%CI
3.87–11.89).
CONCLUSIONS: In our study, TB was associated with
low education level, kitchen type and diabetes, reflecting
the complex interaction between non-communicable
disease, urbanisation and a changing economic climate in
Bangalore. The relationship between TB, the use of
biomass cooking fuels and gender differentials related to
fuel exposure merit further exploration. The study under-
scores the poor nutritional status of patients.
KEY WORDS: epidemiology; tuberculosis; India; risks

INDIA accounts for nearly one third of the global
burden of tuberculosis (TB).1 Although it has the sec-
ond largest and fastest growing DOTS programme in the
world,2 there has not been a discernible reduction in the
incidence of TB in this country.3
TB is associated with the human immunodefi-ciency
virus (HIV) in India, as in other endemic coun-tries;1,4
however, there are few comprehensive data on the
association of smoking, alcohol, occupation and other
socio-economic factors with TB. Few studies have been
performed in developing countries to clar-ify how
different factors interact in the development of active
TB.5 Studies that address risk groups help to prioritise
TB research and intervention among the most vulnerable
in the community, enabling effective and efficient TB
control.2
The aims of this study were to evaluate the role of
demographic, socio-economic and health-related fac-
tors, such as non-communicable diseases, in patients
with TB.
MATERIALS AND METHODS
Setting
All patients attended the TB clinic at St John’s Medi-cal
College Hospital, Bangalore, India. The clinic has an
average annual case load of 109 new adult pulmo-nary
TB (PTB) patients, of which approximately 75% are
smear-positive; the remainder are diagnosed by chest X-
ray (CXR). South India has an annual notifi-cation
incidence rate of 189 per 100 000 population.6
Subjects
All newly diagnosed out-patient PTB patients (n
189) were recruited over 2 years from October 2001,
using the Revised National Tuberculosis Control Pro-
gramme (RNTCP) case definition guidelines.7 Cases
with a previous history of TB, whether partially treated
or relapsed, and patients with severe illness necessitating
in-patient management were excluded to prevent
selection bias in case recruitment.

Correspondence to: Dr Nandini Shetty, Department of Clinical Microbiology, Health Protection Agency Collaborating Cen-tre,
University College London Hospitals, 1st Floor, Windeyer Institute of Medical Sciences, 46 Cleveland Street, London W1T 4JF,
United Kingdom. Tel: ( 44) 020 7380 9518. Fax: ( 44) 020 7580 4175. e-mail: nandini.shetty@uclh.nhs.uk
Article submitted 23 March 2005. Final version accepted 18 July 2005.

Controls
Age- (within 5 years of a case) and sex-matched con-
trols, one for each case, were recruited concurrently
(within 2 weeks of identification of a case) among rel-
atives accompanying non-TB in-patients in the hospi-tal.
TB was ruled out in these patients by their respec-tive
physicians using RNTCP guidelines. At the time of
recruitment, control subjects were not suspected to have
TB.
Ethical approval
The study was approved by the Ethics Committees of
University College London Hospitals, and St John’s
National Academy of Health Sciences, Bangalore.
Written informed consent in the local language was
obtained prior to enrolment.
METHODS
The same structured, closed-ended and pre-coded
questionnaire was administered to all subjects. Con-trols
were interviewed in the hospital when attending to other
patients unrelated to the study. All question-naires were
piloted to remove ambiguity in the transla-tion process
and administered by trained interviewers. Range and
consistency checks were performed to vali-date the
accuracy of data entry. All data were cross-checked a
second time against the questionnaires.
Risk factor variables were grouped into demo-
graphic, socio-economic and personal health-related
factors (Table 1). Demographic variables included
marital status: married and other (single, widowed,
separated, divorced); religion: Hindu and other (Chris-
tian and Muslim); employed (yes or no); occupation:
business/office, skilled, unskilled and dependents (un-
employed, housewives, children and elderly).
Socio-economic/overcrowding characteristics de-
scribed household size ( 4 or 4) and single roomed
houses (yes or no); this was used to calculate persons
per room ( 2 or 2). In addition, separate kitchen (yes or
no); and cooking fuel: biomass fuels (wood, coal, cow
dung and kerosene) and gas/electric were documented.
Total household income per month was characterised as
1000, 1000–5000 or 5000 ru-pees (Rs); household
possessions as none/basic (bi-cycle and transistor) and
‘modcons’ as motorised ve-hicles and electrical gadgets.
Personal health related variables included smoking
and alcohol: never, past ( 6 months ago), current (at least
6 months); chronic disease: diabetes, hyperten-sion,
heart disease (yes or no); and contact with a TB patient
(yes or no).
Body mass index (BMI, kg/m2) 18.5 or 18.5 and mid
upper-arm circumference (MUAC) 24 or 24 cm were
used to anthropometrically ascertain undernutrition. All
subjects were weighed and mea-sured with the same
weighing scale and measuring
Risk factors for TB in South India 81
tape; weighing scales were calibrated daily using stan-
dard weights.
Statistical analysis
The study was designed to have a sample size to detect
an odds ratio (OR) of 1.5–2.0, with 90% power at the
5% significance level for a 1:1 case-control ratio.
Statistical analysis using conditional logistic re-
gression analysis was done with STATA® version 8
(Stata Corp, College Station, TX, USA). Potentially
highly correlated socio-economic variables (house-hold
income/household possessions/people per room,
cooking fuel/separate kitchen, employment/occupation)
were analysed together to check for co-linearity. Simi-
larly, BMI and MUAC were assessed for co-linearity.
RESULTS
Of the 189 cases and controls identified, there were no
refusals. All cases were confirmed either by spu-tum
smear results (81.9%) or by CXR (18.0%). Spu-tum
culture is not routinely performed according to the
RNTCP guidelines.
The age of the subjects ranged from 15 to 83 years;
respectively 27%, 24.9%, 12.7% and 33.3% of sub-jects
were in the 15–24, 25–34, 35–44 and 45 year age
groups. The sex distribution was 58% men and 42%
women. Subjects aged between 11 and 14 years (n 4),
although recruited, were dropped from the analysis.
Univariate analysis
Crude ORs between cases and controls for factors
associated with TB are shown in Table 1.
Higher education (intermediate or college grade) and
higher income ( Rs 5000/month) were signifi-cantly
associated with not being a TB patient, with evidence of
trend between the levels of income (P value for
departure from trend: 0.27). The absence of a separate
kitchen was six times more likely to be as-sociated with
a case of TB (95% confidence interval [CI] 2.53–14.24),
and cooking with biomass fuels (coal, wood, cow dung
and kerosene) had an OR of 1.8 (95%CI 1.10–2.90)
compared to cooking with gas or electricity.
Current smoking was not associated with being a
case of TB, but past smoking was, with evidence of
heterogeneity (P 0.02) between categories. Current
alcohol consumption, chronic disease comprising di-
abetes with or without hypertension and heart disease
and previous contact with a case of TB were not sig-
nificant factors.
Multivariable analysis
Multivariable analysis was done by conditional logis-tic
regression with groups of variables broadly de-scribing
demographic, socio-economic and personal health
related aspects. Level of education, a signifi-
82 The International Journal of Tuberculosis and Lung Disease

Table 1 Effects of factors associated with TB

Cases Controls
(n 189) (n 189)
Characteristic and category n (%) n (%) Crude OR* (95%CI) P value
Marital status
Married 118 (62.4) 117 (61.9) 1
Unmarried ( widowed, separated) 71 (37.6) 72 (38.1) 1.05 (0.58–1.88) 0.88
Religion
Hindu 136 (72.0) 128 (67.7) 1
Other (Christian and Muslim) 53 (28.0) 61 (32.3) 0.80 (0.51–1.27) 0.35
Education
None 34 (18.0) 15 (7.9) 1
School (3–10 years) 56 (29.6) 37 (19.6) 0.57 (0.26–1.24)
Higher 99 (52.4) 137 (72.5) 0.24 (0.11–0.51) 0.001†
Employed
Yes 95 (50.3) 103 (54.5) 1
No 94 (49.7) 86 (45.5) 1.28 (0.78–2.07) 0.32
Occupation
Business 46 (24.5) 55 (29.3) 1
Skilled 25 (13.3) 24 (12.8) 1.20 (0.59–2.44)
Unskilled 55 (29.3) 44 (23.4) 1.59 (0.87–2.93)
Dependents 62 (33.0) 65 (34.6) 1.06 (0.52–2.15) 0.44†
Household size
4/house 84 (44.4) 93 (49.2) 1
4/house 105 (55.6) 96 (50.8) 1.24 (0.81–1.90) 0.33
Household income, Rs
1000 60 (31.8) 43 (22.8) 1
1000–5000 87 (46.03) 75 (39.7) 0.77 (0.46–1.29)
5000 42 (22.2) 71 (37.6) 0.36 (0.20–0.67) 0.001†
House possessions
Modcons‡ 134 (70.9) 151 (79.9) 1
Basic 55 (29.1) 38 (20.1) 1.65 (1.02–2.69) 0.04
Single roomed houses
No 137 (72.5) 136 (71.96) 1
Yes 52 (27.5) 53 (28.04) 0.97 (0.60–1.58) 0.90
People per room
2 137 (72.5) 136 (72.0) 1
2 52 (27.5) 53 (28.0) 0.79 (0.53–1.19) 0.26
Separate kitchen
Yes 150 (79.3) 179 (95.2) 1
No 40 (20.6) 8 (4.8) 6.00 (2.53–14.24) 0.0001
Cooking fuel
Gas/electric 113 (59.8) 133 (70.4) 1
Biomass fuels 76 (40.2) 56 (29.6) 1.80 (1.10–2.90) 0.02
Smoking
Never 125 (66.1) 136 (72.0) 1
Past 35 (18.5) 20 (10.6) 2.31 (1.12–4.79)
Current 29 (15.3) 33 (17.5) 1.17 (0.59–2.33) 0.55§
Alcohol
Never 130 (68.8) 139 (73.5) 1
Past 25 (13.2) 29 (15.3) 1.06 (0.54–2.08)
Current 34 (18.0) 21 (11.1) 2.13 (1.02–4.44) 0.06†
Chronic disease
No 147 (77.8) 159 (84.1) 1
Yes 42 (22.2) 30 (15.9) 1.80 (1.10–2.93) 0.07
TB contact
Yes 65 (34.4) 59 (31.2) 1
No 124 (65.6) 130 (68.8) 1.24 (0.73–2.10) 0.42
BMI
18.5 49 (27.1) 143 (76.1) 1
18.5 132 (72.9) 45 (23.9) 11.11 (5.62–21.98) 0.0001
Missing 8 1
MUAC
24 cm 55 (30.4) 142 (75.9) 1
24 cm 126 (69.6) 45 (24.1) 6.79 (3.87–11.89) 0.0001
Missing 8 2
* Univariate analysis performed on 185 matched pairs (4 case-control pairs aged 15 years not included).
†
Test for trend.
‡ Modcons: motorised vehicles and electrical household
gadgets. § Test for departure from linear trend, P 0.02.
TB tuberculosis; OR odds ratio; CI confidence interval; Rs rupees; BMI body mass index; MUAC mid upper arm circumference.
 Risk factors for TB in South India 83

Table 2 Multivariable analysis: conditional logistic regression model for risk

factors for TB (n 185 matched pairs)

Unadjusted OR Adjusted OR
Variable and category OR (95%CI) P value OR (95%CI) LRT P value
Education
None 1 1
School (3–10 years) 0.57 (0.26–1.24) 0.59 (0.23–1.50)
Higher 0.24 (0.11–0.51) 0.001* 0.30 (0.11–0.82) 0.03
Household income, Rs
1000 1 1
1000–5000 0.77 (0.46–1.29) 0.86 (0.48–1.54)
5000 0.37 (0.20–0.68) 0.001* 0.52 (0.25–1.10) 0.08
Persons per room
2 1 1
2 0.79 (0.53–1.19) 0.26 1.03 (0.89–1.19) 0.66
Separate kitchen
Yes 1 1
No 6.00 (2.53–14.24) 0.0001 3.26 (1.25–8.46) 0.02
Cooking fuel
Gas/electric 1 1
Biomass fuels 1.80 (1.10–2.90) 0.02 0.90 (0.46–1.76) 0.75
Alcohol
Never 1 1
Past 1.06 (0.54–2.08) 0.95 (0.42–2.18)
Current 2.13 (1.02–4.44) 0.06* 2.37 (0.95–5.93) 0.07
Smoking
Never 1 1
Past 2.31 (1.12–4.79) 2.37 (1.0–5.62)
Current 1.17 (0.59–2.33) 0.55† 0.80 (0.34–1.89) 0.84
Chronic disease
No 1 1
Yes 1.80 (1.10–2.93) 0.07 2.44 (1.17–5.09) 0.02

* Test for trend.

†
Test for departure from linear trend, P 0.02.
TB tuberculosis; OR odds ratio; CI confidence interval; LRT likelihood ratio test; Rs rupees.

cant factor in univariate analysis, was retained in the
model after adjusting for other demographic vari-ables,
i.e., marital status and religion. Household in-come,
persons per room, separate kitchen and cook-ing fuel
were representative of socio-economic status and
overcrowding; they did not correlate with each other.
Alcohol consumption, smoking and chronic disease
were included in the model to account for per-sonal
health related risk factors.
The results of the multivariable analysis are pre-
sented in Table 2. The OR of 0.30 for education level
(95%CI 0.11–0.82) remained significant after adjust-
ment with other variables in the final model. The ef-fect
of having a separate kitchen also remained signif-icant
in the multivariable model (OR 3.26; 95%CI 1.25–8.46).
The OR for chronic disease (diabetes with or without
hypertension and/or heart disease) was even higher
(adjusted OR 2.44; 95%CI 1.17– 5.09).
Interaction within age group and sex
The OR for not having a separate kitchen as a risk factor
for TB did not vary significantly between age groups;
however, there was significant interaction with sex (OR
for men 2.17, 95%CI 0.82–5.70; OR for women 23.0,
95%CI 3.1–170.3; P 0.01). There
was no sex interaction between male and female sub-
jects with regard to the effect of cooking fuel on TB (OR
1.45, 95%CI 0.68–3.13 vs. OR 2.07, 95%CI 1.09–3.92;
P 0.49). In the multivariable analysis (Table 2), the
interaction between sex and not having a separate
kitchen was significant (likelihood ratio test [LRT]
0.04), whilst that between sex and type of cooking fuel
used was not (LRT 0.18).
Nutritional assessment
BMI ranged from 11.26 to 30.7 (median 18.63) and
MUAC from 16.5 to 36.7 cm (median 24.0 cm). Pa-
tients with TB were 11 times more likely to have a BMI
18.5 (95%CI 5.62–21.98) and seven times more likely to
have an MUAC 24 cm (95%CI 3.87–11.89).
DISCUSSION
To control TB it is essential to understand the com-plex
risk factors and socio-economic dimensions of the
disease in a community. Recent studies have focused on
the influence of HIV on TB, but have not assessed other
risk factors.1,4 A matched study design was used to
enable us to concentrate on less well studied risk factors
other than age and sex. Several studies have supported
the strong confounding effects of age and
84 The International Journal of Tuberculosis and Lung Disease
sex on the incidence of TB globally and in India.8–10
Studies from South India have also shown that the
prevalence of TB was higher in males than females at all
ages: it was low in children under 10 years of age,
increasing appreciably with age and reaching a peak
between 20 and 40 years of age.11,12
In our study, a higher level of education was signifi-
cantly protective against TB; this was also found in an
age- and sex-matched case control study from South
Africa.13
TB is a disease of poverty, associated with resource-
poor countries. However, the association of specific
socio-economic factors and TB is not clear.14 In Guinea-
Bisssau, adult overcrowding was a risk factor for TB.15
We used the number of persons per room as a measure
of overcrowding and found that it was not a significant
risk factor for TB. One study from Malawi showed that
higher socio-economic status was associ-ated with TB,
probably reflecting increased awareness and hence
greater likelihood of diagnosis.16 Studies from China
have revealed that TB was negatively cor-related with
per capita income; good household eco-nomic
conditions were a protective factor.17,18
In our study, household income and possessions, not
having a separate kitchen and type of cooking fuel were
used as proxy measures for socio-economic status.
These were significant factors for being a TB patient in
univariate analysis, and the direction of ef-fect was
similar in multivariate analysis. However, not having a
separate kitchen was the only socio-economic variable
that remained significant. We found the effect of
cooking fuel to be confounded by not hav-ing a separate
kitchen; however, the latter remained a significant factor
for TB after adjusting other factors of socio-economic
status. From our study, it is not clear whether not having
a separate kitchen represents socio-economic status or
exposure to fumes while cooking with biomass fuels and
merits further study. A study of over 88 000 households
in India, adjusted for demographic and socio-economic
variables, showed a high prevalence of TB in
households that used bio-mass fuels for cooking.19 They
suggest that this effect is reduced when the availability
of a separate kitchen is accounted for.19 A study from
Malawi, however, showed no effect of cooking smoke
on TB.10 Clearly more studies are required to support
this hypothesis.
In our study, the OR for the effect of not having a
separate kitchen on TB varied significantly between men
and women (OR 2.17, 95%CI 0.82–5.70 vs. 23.0,
95%CI 3.1–170.3). The wide CI reflects small numbers,
hence the results need to be interpreted with caution. In
other studies the OR for the effect of cooking fuel did
not vary significantly between men and women.10,19
Further studies that specifically ad-dress such gender
issues are needed to explore these findings further.
Our study showed no effect of alcohol consump-tion
or smoking on TB in multivariate analysis. In
contrast, two case control studies from Spain20,21 and
one from South Africa22 have reported on the signifi-
cant effect of alcohol as a risk for TB. Tobacco smok-
ing as a risk factor for men with TB was demonstrated in
an age-matched case control study from South India;23
whether this association was confounded by other socio-
economic or demographic factors is not mentioned. In
our study, univariate analysis demon-strated an
association with past smoking; however, it is possible
that there was not enough power to dem-onstrate this
effect in multivariate analysis; further studies are needed
to clarify the association.
We found a strong association for TB in patients with
chronic disease—diabetes alone or with hyper-tension
and coronary heart disease. Other workers have
demonstrated the association of diabetes with TB.24,25
As a result of rapid economic transition in countries
such as India, the complex relationship be-tween
communicable and non-communicable dis-eases is
particularly relevant and merits further study.
Case control studies such as ours cannot assess the
role of malnutrition in the development of TB, as the
disease itself causes wasting. Our study clearly shows
that TB is associated with under-nutrition; further-more
it controls for alcohol consumption which can be
strongly immunosuppressive and substantially af-fect
nutrition.26 These findings endorse Cegielski and
McMurray’s suggestion that nutritional support of
undernourished populations at high risk of TB may
reduce the incidence of TB in such groups.27
Limitations of the study
There were missing values only for the BMI and MUAC
measurements; these data were available for 180 of the
185 (97%) case-control pairs analysed. Of the five
missing case control pairs, three were male and two
female; they belonged to the 15–24 (n 1), 25–34 (n 1),
35–44 (n 1) and 45 (n 2) year age groups. We believe
the numbers of missing pairs in each category were
small, and that it is unlikely that their exclusion would
cause bias.
Reverse causality for variables such as alcohol con-
sumption and smoking need to be addressed, as onset of
TB may alter these behaviour patterns. We tried to avoid
this by ensuring that a detailed history of at least 6
months’ duration was established for current smokers
and for alcohol consumption.
Recall bias may distort the associations, as cases may
have better recall than control subjects. Although our
interviewers were not blinded to case or control status,
they were trained not to influence answers.
Overmatching could be a potential problem, as cases
were age and sex matched. However, we feel this could
be beneficial, as these are well known con-founders and
we could assess other risk factors with-out the
confounding influence of age and sex. Matched studies
may overmatch for socio-economic factors, yielding
non-significant results; in our study educa-

tion, household income and a separate kitchen were
significant associations despite matching. More power
may be needed to ascertain the true significance of the
other socio-economic risk factors; larger studies are
needed to confirm negative associations.
Selection of controls from those attending other
patients in hospital could potentially mean that these
subjects were exposed to TB or were either health
conscious or jobless. The former was ruled out when the
patient being cared for by a potential control sub-ject
was carefully screened for TB. The latter was not a
major issue, as the controls were still likely to rep-resent
the same population that produced the cases. If the
control subjects were to develop TB they would attend
the same chest clinic as the TB patients.
CONCLUSIONS
Interventions for TB need to be appropriate for those
most at risk. As shown by this study they need to be
sensitive to other health care needs of TB patients such
as socio-demographic status, associated chronic disease
and nutritional vulnerability. Effective socio-economic
markers and indices for overcrowding are necessary to
identify those at risk: lack of separate cooking facilities
in a rapidly urbanising metropolis such as Bangalore
may be a risk factor for TB. Gender differentials in the
assessment of such risk factors and exposure to biomass
cooking fuels need to be further explored. The
relationship between chronic non-communicable
diseases and TB merits further study and is particularly
relevant in a country in economic transition such as
India.
Acknowledgements
Thanks are due to all our study subjects, and in particular to our field
workers Mr S Nithyanandan, Ms S Leumas and Ms S Anand for their
commitment to the study. Funding from the Health Pro-tection
Agency, UK, and Prof A Zumla of the University College London,
Special Trustees, is gratefully acknowledged.
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86 The International Journal of Tuberculosis and Lung Disease
CONTEXTE : On ne connaît que peu de données sur les
facteurs de risque associés à la tuberculose (TB) en
Inde. OBJECTIFS : Evaluer les facteurs de risque
sociodémo-graphiques potentiels pour la TB.
SCHÉMA : Etude cas-contrôle appariée. Les cas étaient
tous de nouveaux diagnostics de TB pulmonaire se
présentant comme patients externes à l’Hôpital du St
John’s Medical College à Bangalore, Inde, entre octobre
2001 et octobre 2003. Les contrôles, un par cas (n
189) étaient appariés pour l’âge et le sexe parmi les
membres de la famille accompagnant des patients non-
tuberculeux à l’hôpital.
RÉSULTATS : Les facteurs de risqué significatifs ont été
un faible niveau d’éducation (OR 0,30 ; IC95% 0,11–
0,82), le fait de ne pas disposer d’une cuisine séparée
(OR 3,26 ; IC95% 1,25–8,46) et une maladie chro-nique,
particulièrement le diabète (OR 2,44 ; IC95%
MARCO DE REFERENCIA : Existen pocos datos sobre los
factores de riesgo de tuberculosis (TB) en la India.
OBJETIVO : Evaluar los posibles factores de riesgo socio-
demográficos de la TB.
MÉTODO : Fue este un estudio de casos y testigos em-
parejados. El grupo de estudio fueron todos los pa-
cientes ambulatorios con diagnóstico reciente de TB
pul-monar que acudieron al hospital del St John’s
Medical College en Bangalore, India, entre octubre de
2001 y oc-tubre de 2003. Los testigos, uno por cada caso
(n 189) y emparejados con respecto a la edad y al sexo,
se esco-gieron entre los familiares acompañantes de
pacientes con diagnóstico diferente de TB,
hospitalizados en la misma institución.
RESULTADOS : Los factores de riesgo con significación
estadística fueron el bajo nivel de educación (OR 0,30 ;
IC95% 0,11–0,82), la falta de una cocina independiente
(OR 3,26 ; IC95% 1,25–8,46) y la presencia de enfer-
medad crónica, en particular diabetes (OR 2,44 ; IC95%
RÉSUMÉ
1,17–5,09). A l’analyse multivariée, on n’a pas trouvé de
relation significative avec un revenu élevé, avec le fait
d’utiliser des combustibles végétaux pour cuisiner et
avec des antécédents de consommation de tabac et d’al-
cool. Les patients avaient un risque respectivement 11 et
sept fois supérieur d’avoir un index de masse corporelle
18,5 (IC95% 5,62–21,98) et une circonférence à mi-bras
24 cm (IC95% 3,87–11,89).
CONCLUSIONS : Dans notre étude, la TB est associée à un
faible niveau d’éducation, au type de cuisine et au di-abète,
ce qui reflète l’interaction complexe entre des ma-ladies
non transmissibles, l’urbanisation et un climat économique
changeant à Bangalore. Les relations entre la TB,
l’utilisation de combustibles végétaux et les dif-férences
par sexe liées à l’exposition aux combustibles méritent une
exploration complémentaire. Cette étude souligne le
médiocre état nutritionnel des patients.
RESUMEN
1,17–5,09). En el análisis de variables múltiples no
alcan-zaron una significación estadística los altos
ingresos, la utilización de combustibles de biomasa para
cocción de alimentos, los antecedentes de tabaquismo ni
el con-sumo de alcohol. Los pacientes con un índice de
masa corporal 18,5 presentaron un riesgo de TB 11
veces mayor (IC95% 5,62–21,98) y aquellos con una
circun-ferencia media del brazo 24 cm tuvieron un
riesgo siete veces mayor (IC95% 3,87–11,89).
CONCLUSIONES : En este estudio se encontró una corre-
lación entre el riesgo de TB y el bajo nivel de educación,
el tipo de cocina y la diabetes, que sugiere una interac-
ción compleja entre las enfermedades no contagiosas, la
urbanización y el clima de inestabilidad económica que
prevalece en Bangalore. La correlación entre TB y el
uso de combustibles de biomasa y las diferencias entre
los sexos con respecto a la exposición al combustible re-
querirían una mayor investigación. El estudio puso de
manifiesto el mal estado nutricional de los pacientes.