TY - JOUR
T1 - Lung function and respiratory symptoms after tuberculosis in an American indian population the strong heart study
AU - Powers, Martha
AU - Sanchez, Tiffany R.
AU - Welty, Thomas K.
AU - Cole, Shelley A.
AU - Oelsner, Elizabeth C.
AU - Yeh, Fawn
AU - Turner, Joanne
AU - O'Leary, Marcia
AU - Brown, Robert H.
AU - O'Donnell, Max
AU - Lederer, David
AU - Navas-Acien, Ana
N1 - Funding Information:
Supported by the Strong Heart Study, which has been funded, in whole or in part, with National Heart, Lung, and Blood Institute, National Institute of Health, Department of Health and Human Services grants 75N92019D00027, 75N92019D00028, 75N92019D00029, and 75N92019D00030, and by National Institute of Environmental Health Sciences grants P42ES010349, P42ES010349, P30ES009089, R01ES025216, and R01ES028758; this study was also supported by training grants 5T32ES007141-32 (M.P.) and F31ES028597 (M.P.).
Funding Information:
1Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; 2Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York; 3Retired U.S. Public Health Service, Tuba City, Arizona; 4Texas Biomedical Research Institute, San Antonio, Texas; 5Department of Medicine, and 9Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center, New York, New York; 6Center for American Indian Health Research, University of Oklahoma Health Sciences Center, College of Public Health, Oklahoma City, Oklahoma; 7Missouri Breaks Industries Research, Inc., Eagle Butte, South Dakota; 8Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland; 10Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
Publisher Copyright:
© 2020 by the American Thoracic Society.
PY - 2020
Y1 - 2020
N2 - Rationale: Permanent lung function impairment after active tuberculosis infection is relatively common. It remains unclear which spirometric pattern is most prevalent after tuberculosis. Objectives: Our objective was to elucidate the impact of active tuberculosis survival on lung health in the Strong Heart Study (SHS), a population of American Indians historically highly impacted by tuberculosis. As arsenic exposure has also been related to lung function in the SHS, we also assessed the joint effect between arsenic exposure and past active tuberculosis. Methods: The SHS is an ongoing population-based, prospective study of cardiovascular disease and its risk factors in American Indian adults. This study uses tuberculosis data and spirometry data from the Visit 2 examination (1993-1995). Prior active tuberculosis was ascertained by a review of medical records. Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and FEV1/FVC were measured by spirometry. An additional analysis was conducted to evaluate the potential association between active tuberculosis and arsenic exposure. Results: A history of active tuberculosis was associated with reduced percent predicted FVC and FEV1, an increased odds of airflow obstruction (odds ratio = 1.45, 95% confidence interval = 1.08-1.95), and spirometric restrictive pattern (odds ratio = 1.73, 95% confidence interval = 1.24-2.40). These associations persisted after adjustment for diabetes and other risk factors, including smoking. We also observed the presence of cough, phlegm, and exertional dyspnea after a history of active tuberculosis. In the additional analysis, increasing urinary arsenic concentrations were associated with decreasing lung function in those with a history of active tuberculosis, but a reduced odds of active tuberculosis was found with elevated arsenic. Conclusions: Our findings support existing knowledge that a history of active tuberculosis is a risk factor for long-term respiratory impairment. Arsenic exposure, although inversely associated with prior active tuberculosis, was associated with a further decrease in lung function among those with a prior active tuberculosis history. The possible interaction between arsenic and tuberculosis, as well as the reduced odds of tuberculosis associated with arsenic exposure, warrants further investigation, as many populations at risk of developing active tuberculosis are also exposed to arsenic-contaminated water.
AB - Rationale: Permanent lung function impairment after active tuberculosis infection is relatively common. It remains unclear which spirometric pattern is most prevalent after tuberculosis. Objectives: Our objective was to elucidate the impact of active tuberculosis survival on lung health in the Strong Heart Study (SHS), a population of American Indians historically highly impacted by tuberculosis. As arsenic exposure has also been related to lung function in the SHS, we also assessed the joint effect between arsenic exposure and past active tuberculosis. Methods: The SHS is an ongoing population-based, prospective study of cardiovascular disease and its risk factors in American Indian adults. This study uses tuberculosis data and spirometry data from the Visit 2 examination (1993-1995). Prior active tuberculosis was ascertained by a review of medical records. Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and FEV1/FVC were measured by spirometry. An additional analysis was conducted to evaluate the potential association between active tuberculosis and arsenic exposure. Results: A history of active tuberculosis was associated with reduced percent predicted FVC and FEV1, an increased odds of airflow obstruction (odds ratio = 1.45, 95% confidence interval = 1.08-1.95), and spirometric restrictive pattern (odds ratio = 1.73, 95% confidence interval = 1.24-2.40). These associations persisted after adjustment for diabetes and other risk factors, including smoking. We also observed the presence of cough, phlegm, and exertional dyspnea after a history of active tuberculosis. In the additional analysis, increasing urinary arsenic concentrations were associated with decreasing lung function in those with a history of active tuberculosis, but a reduced odds of active tuberculosis was found with elevated arsenic. Conclusions: Our findings support existing knowledge that a history of active tuberculosis is a risk factor for long-term respiratory impairment. Arsenic exposure, although inversely associated with prior active tuberculosis, was associated with a further decrease in lung function among those with a prior active tuberculosis history. The possible interaction between arsenic and tuberculosis, as well as the reduced odds of tuberculosis associated with arsenic exposure, warrants further investigation, as many populations at risk of developing active tuberculosis are also exposed to arsenic-contaminated water.
KW - American Indian
KW - Arsenic
KW - Spirometry
KW - Strong Heart Study
KW - Tuberculosis
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U2 - 10.1513/AnnalsATS.201904-281OC
DO - 10.1513/AnnalsATS.201904-281OC
M3 - Article
C2 - 31553638
AN - SCOPUS:85077402407
SN - 2325-6621
VL - 17
SP - 38
EP - 48
JO - Annals of the American Thoracic Society
JF - Annals of the American Thoracic Society
IS - 1
ER -