Abstract:
Background: Tuberculosis is a major public health problem caused by Mycobacterium tuberculosis, occurring
predominantly in population with low socioeconomic status. It is the second most common cause of death from
infectious diseases. Tuberculosis becomes a double burden among anemic patients. Anemia increases an
individual’s susceptibility to infectious diseases including tuberculosis by reducing the immunity level. Therefore, the
purpose of this study was to determine whether anemia is a risk factor for tuberculosis.
Method: Relevant published articles were searched in electronic databases like PubMed, Google Scholar, EMBASE,
and Cochrane Library using the following MeSH terms: risk factor, predictors, tuberculosis, TB, Anaemia, Anemia,
hemoglobin, Hgb, and Hb. Articles written in the English, observational studies conducted on the incidence/
prevalence of tuberculosis among anemic patients, or papers examined anemia as risk factors for tuberculosis were
included. From those studies meeting eligibility criteria, the first author’s name, publication year, study area, sample
size and age of participants, study design, and effect measure of anemia for tuberculosis were extracted. The data
were entered using Microsoft Excel and exported to Stata version 11 for analysis. The random-effects model was
applied to estimate the pooled OR and HR, and 95% CI. The sources of heterogeneity were tested by Cochrane Isquared statistics. The publication bias was assessed using Egger’s test statistics.
Results: A total of 17 articles with a 215,294 study participants were included in the analysis. The odd of tuberculosis
among anemic patients was 3.56 (95% CI 2.53–5.01) times higher than non-anemic patients. The cohort studies
showed that the HR of tuberculosis was 2.01 (95% CI 1.70–2.37) times higher among anemic patients than non-anemic
patients. The hazard of tuberculosis also increased with anemia severity (HR 1.37 (95% CI 0.92–2.05), 2.08 (95% CI 1.14–
3.79), and 2.66 (95% CI 1.71–4.13) for mild, moderate, and severe anemia, respectively).
Conclusion: According to the current systematic review and meta-analysis, we can conclude that anemia was
a risk factor for tuberculosis. Therefore, anemia screening, early diagnose, and treatment should be provoked
in the community to reduce the burden of tuberculosis.
Keywords: Anemia, Tuberculosis, Systematic review, Hazard ratio, and Meta-analysi
