Tuberculosis (TB) remains a significant public health problem in Canadian Inuit communities. In 2016, Canadian Inuit had an incidence rate 35 times the Canadian average. Tobacco use is an important risk factor for TB, and over 60% of Inuit adults smoke. We aimed to estimate changes in TB-related outcomes and costs from reducing tobacco use in Inuit communities.
Using a transmission model to estimate the initial prevalence of latent TB infection (LTBI), followed by decision analysis modelling, we conducted a cost-effectiveness analysis that compared the current standard of care for management of TB and LTBI without additional tobacco reduction intervention (Status Quo) with (1) increased tobacco taxation, (2) pharmacotherapy and counselling for smoking cessation, (3) pharmacotherapy, counselling plus mass media campaign, and (4) the combination of all these. Projected outcomes included the following: TB cases, TB-related deaths, quality-adjusted life years (QALYs), and health system costs, all over 20?years.
The combined strategy was projected to reduce active TB cases by 6.1% (95% uncertainty range 4.9-7.0%) and TB deaths by 10.4% (9.5-11.4%) over 20?years, relative to the status quo. Increased taxation was the only cost-saving strategy.
Currently available strategies to reduce commercial tobacco use will likely have a modest impact on TB-related outcomes in the medium term, but some may be cost saving.
The correlation analysis was used to examine the epidemiological indices of the morbidity of tuberculosis, pneumonia, chronic bronchitis, bronchial asthma, and lung cancer in the Astrakhan region in 1987-1994. The indices were compared with each other and with varying air, water, and soil levels of toxicants. The magnitude of the effects of pollutants on the incidence of respiratory diseases ranged from 61% (for tuberculosis) to 93.3% (for pneumonia). The effects of the water and soil concentrations of toxicants proved to be less insignificant, by varying from 28.7% in tuberculosis to 4.8% in lung cancer. The effects of toxicant levels on tuberculosis morbidity are 5 times less than those during fibrous-cavernous processes and twice less than in first detected tuberculosis at the stage of decay with bacterial isolation. The pollutants containing sulfur were found to adversely affect mainly patients with tuberculosis or lung cancer. The study makes it necessary to consider patients with the aforesaid diseases as the objects of ecological pressing that directly has impact on the course of diseases and their outcomes.