Cannabis use and the risk of tuberculosis: a systematic review

被引:10
作者
French, Clare E. [1 ,2 ]
Coope, Caroline M. [2 ,3 ]
McGuinness, Luke A. [1 ,2 ]
Beck, Charles R. [2 ,3 ]
Newitt, Sophie [4 ]
Ahyow, Lauren [5 ]
Hickman, Matt [1 ,2 ]
Oliver, Isabel [2 ,3 ]
机构
[1] Univ Bristol, Bristol Med Sch, Populat Hlth Sci, Bristol BS8 2PS, Avon, England
[2] Univ Bristol, Natl Inst Hlth Res Hlth Protect Unit Evaluat Inte, Bristol Med Sch, Bristol BS8 2PS, Avon, England
[3] Publ Hlth England, Field Serv South West, Natl Infect Serv, Bristol BS1 6EH, Avon, England
[4] Publ Hlth England, Field Serv East Midlands, Natl Infect Serv, Nottingham NG2 4LA, England
[5] Publ Hlth England, Publ Hlth England East Midlands, Nottingham NG2 4LA, England
关键词
Tuberculosis; Cannabis; Systematic review; Evidence synthesis; MARIJUANA; OUTBREAK; SMOKING; INFECTION;
D O I
10.1186/s12889-019-7127-0
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
BackgroundCannabis has been identified as a possible risk factor in some tuberculosis (TB) outbreaks. As the most widely used (largely) illegal substance in Western countries this may be an important public health concern. We aim to systematically review the evidence on the association between cannabis use and TB (latent infection and active disease) to inform ongoing and future TB prevention and control strategies.MethodsWe conducted a systematic review. We searched Ovid Medline, Embase and PsycInfo, together with the World Health Organization website and Google Scholar, for all years to January 2018. Reference lists and conference abstracts were hand-searched, a forward citation search was conducted on the Web of Science, and experts were contacted. Two authors independently screened studies for inclusion, extracted data and assessed risk of bias using an adapted version of ROBINS-I (Risk of Bias in Non-randomised Studies - of Interventions). Data were narratively synthesised.ResultsOf 377 records identified, 11 studies were eligible. Study designs were heterogeneous. Six studies utilised a relevant comparator group. Four of these investigated the association between cannabis use and latent TB infection; all provided some evidence of an association, although only two of these had adjusted for confounders. The remaining two comparator studies investigated the association between cannabis use and active TB disease; neither found evidence of an association after adjusting for confounding. All six studies were at Serious risk of bias. The five studies which did not utilise a relevant comparator group were all indicative of TB outbreaks occurring among cannabis users, but the quality of the evidence was very weak.ConclusionsEvidence for an association between cannabis use and TB acquisition is weak. The topic warrants further robust primary research including the collection of consistent and accurate exposure information, including cannabis use practices, dose and frequency, and adjustment for confounders.
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