Nation-based case-control study investigating the relationship between oral corticosteroids use and pulmonary tuberculosis.

Abstract

BACKGROUND AND OBJECTIVE: No published formal study focuses on the relationship between oral corticosteroids use and pulmonary tuberculosis in Taiwan. The aim of the study was to investigate whether oral corticosteroids use was associated with increased odds of pulmonary tuberculosis. METHODS: The retrospective, nation-based, case-control study was conducted to analyze the database of the Taiwan National Health Insurance Program between 2000 and 2013. Subjects aged 20 to 84years with newly diagnosed pulmonary tuberculosis were defined as the cases (n=6021). Randomly selected subjects without pulmonary tuberculosis aged 20 to 84years were defined as the controls (n=6021). Subjects who never had a prescription for oral corticosteroids were defined as never use. Subjects who ever had a prescription for oral corticosteroids were defined as ever use. RESULTS: After adjustment for confounders, the adjusted odds ratio of pulmonary tuberculosis was 1.91 for subjects with even use of oral corticosteroids (95% confidence interval 1.73, 2.11), comparing with never use. The adjusted odds ratio of pulmonary tuberculosis was 1.03 for subjects with increasing cumulative dose of oral corticosteroids for per milligram (95% confidence interval 1.02, 1.03), comparing with never use. In addition, the adjusted odds ratios of pulmonary tuberculosis were 1.83 (95% CI 1.65, 2.02) for subjects with cumulative duration of oral corticosteroids<3months, and 2.12 (95% CI 1.87, 2.40) for subjects with cumulative duration≥3months, comparing with never use. CONCLUSION: Though the finding is not unexpected, use of oral corticosteroids is significantly associated with 1.9-fold increased odds of pulmonary tuberculosis, independent of other risk comorbidities. There are dose-dependent and duration-dependent effects of oral corticosteroids use on the risk of pulmonary tuberculosis.