Risk of incident active tuberculosis and use of corticosteroids

OBJECTIVE : To examine the association between corticosteroid use and risk of active tuberculosis (TB) disease. METHODS : We conducted a population-based nested case-control study based on Taiwan's National Health Insurance Research Database between January 1999 and December 2011. Each case of incident active TB was matched to 100 controls using a risk-set sampling scheme. RESULT S : From a participant cohort of 1 million, 6229 cases of new active TB and 622 900 controls were identified. Current, recent, past, ever and chronic use of corticosteroids were associated with an increased risk of developing incident active TB, with adjusted rate ratios of respectively 2.76 (95%CI 2.44-3.11), 1.99 (95%CI 1.73-2.31), 1.17 (95%CI 1.06-1.29), 1.60 (95%CI 1.49-1.72), and 1.58 (95%CI 1.43-1.75). For subgroup analysis, the increased risk of TB in chronic corticosteroids users was substantially higher in subjects aged 670 years and female subjects. CONCLUS ION : In this relatively high TB prevalence setting, we found that use of corticosteroids was associated with an increased risk of TB. Current use of corticosteroids was associated with the highest risk of TB.