The WHO report also tells us that in 2021 these were also the top 5 TB risk factors in the whole of Asia Pacific region: undernourishment (1.2 million new TB cases), tobacco use (502,000 new TB cases), alcohol (486,000 new TB cases), diabetes (234,000 new TB cases), and HIV (209,000 new TB cases).
To end TB we have to end tobacco
"We cannot end TB unless we end tobacco smoking," said Mukta Sharma of WHO. It is important to note that whether a person is smoking tobacco or exposed to passive smoking, the risk of TB disease goes up by 6 to 9 times. "In Indonesia, 77% of TB patients were smokers - much higher than other countries in the region," said Sharma.
Dr Ayu Swandewi Astuti, from Udayana University in Indonesia, emphasised that efforts to end TB must be in tandem with efforts to end tobacco smoking, alcohol consumption and undernourishment; prevent diabetes; and ensure that every person with HIV is receiving the full cascade of HIV-care services.
"In Indonesia and the 30 countries with the highest TB burden, men are at higher risk of TB than women because most (60%) men aged over 15 years smoke cigarettes," said Indonesian Health Minister Budi Gunadi Sadikin.
Instead of declining, tobacco smoking has increased in Indonesia
"In the last 10 years, the number of adult smokers in Indonesia has increased significantly by 8.8 million - from 60.3 million smokers in 2011 to 69.1 million smokers in 2021. The results of the Global Adults Tobacco Survey (GATS) also show a 10-fold increase in the prevalence of electronic smoking- from 0.3% in 2011 to 3% in 2021. Meanwhile, the prevalence of secondhand smoke has also risen to 120 million people," said Sadikin.
Studies show that tobacco smokers are at 2-3 times higher risk of TB disease progressing from latent TB to active TB disease; treatment outcomes are less optimal and risk of death is also higher in them. Having non-communicable diseases (NCDs) like diabetes further elevates the TB risk. "TB is one of the leading causes of death in smokers, with 15.2% of deaths from TB related to smoking, so smoking as a major risk factor for TB can hinder the target of reducing TB incidence and mortality by 2030," said Sadikin.
(Note: You can view every article as one long page if you sign up as an Advocate Member, or higher).
