{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T07:23:32Z","timestamp":1780730612569,"version":"3.54.1"},"reference-count":29,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2022,8,4]],"date-time":"2022-08-04T00:00:00Z","timestamp":1659571200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004697","name":"Hamadan University of Medical Sciences","doi-asserted-by":"publisher","award":["9810107547"],"award-info":[{"award-number":["9810107547"]}],"id":[{"id":"10.13039\/501100004697","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>The mycobacterium tuberculosis (Mtb) is necessary for the morbidity of tuberculosis (TB), but it is insufficient. Many risk factors increase the risk of disease among infected people. We aimed to estimate the prevalence of modifiable risk factors of TB and their related population attributable fraction (PAF) in the marginal population of Markazi province in Iran.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Design<\/jats:title>\n<jats:p>In this cross-sectional study, the prevalence of the modifiable risk factors of TB was estimated. We designed and validated a questionnaire to determine the risk factors. The measures of association for the modifiable risk factors of TB were obtained via the review of published literature. We calculated the PAF for each modifiable risk factor.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Out of the 1275 calculated sample size, 1146 people participated in this study, and the participation rate was 89.9%. The mean age was 39.26. Out of 1146 participants, 76% did not know anything regarding TB. The highest prevalence was related to the lack of physical activity (58.73%), lack of fish consumption (50.79%), lack of red meat consumption (21.20%), and secondhand smoke (19.02%). The highest PAF was related to secondhand smoke; this value based on the crude relative risk (RR) and crude odds ratio (OR) was 24.54% and 23.44%, respectively. Based on crude hazard ratio (HR) and crude OR, the PAF for smoking was 14.81% and 11.19%, respectively. PAF for lack of BCG vaccination based on the crude OR was 14.79%.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Based on this study\u2019s results, poor nutrition, secondhand smoke, smoking, lack of BCG vaccination, and diabetes are the main prevalent modifiable risk factors for TB. The highest PAF for TB was related to secondhand smoke, smoking, lack of BCG vaccination, and diabetes.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0271511","type":"journal-article","created":{"date-parts":[[2022,8,4]],"date-time":"2022-08-04T17:52:10Z","timestamp":1659635530000},"page":"e0271511","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":12,"title":["Prevalence of modifiable risk factors of tuberculosis and their population attributable fraction in Iran: A cross-sectional study"],"prefix":"10.1371","volume":"17","author":[{"given":"Kamal","family":"Sadeghi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jalal","family":"Poorolajal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0623-7503","authenticated-orcid":true,"given":"Amin","family":"Doosti-Irani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,8,4]]},"reference":[{"key":"pone.0271511.ref001","article-title":"Global tuberculosis report 2020 2020 [updated May 26, 2021].","author":"World health organization"},{"key":"pone.0271511.ref002","unstructured":"World health organization. Tuberculosis profile: Iran (Islamic Republic of) 2021 [updated 2021]. Available from: https:\/\/worldhealthorg.shinyapps.io\/tb_profiles\/?_inputs_&entity_type=%22country%22&lan=%22EN%22&iso2=%22IR%22."},{"issue":"03","key":"pone.0271511.ref003","doi-asserted-by":"crossref","first-page":"353","DOI":"10.26911\/jepublichealth.2018.03.03.06","article-title":"Individual and Environmental Risk Factors of Tuberculosis: A New Evidence from Ponorogo, East Java","volume":"3","author":"D Sayidah","year":"2018","journal-title":"Journal of Epidemiology and Public Health"},{"issue":"4","key":"pone.0271511.ref004","doi-asserted-by":"crossref","first-page":"e0214235","DOI":"10.1371\/journal.pone.0214235","article-title":"Risk factors for tuberculosis: a case\u2013control study in Addis Ababa, Ethiopia","volume":"14","author":"E Shimeles","year":"2019","journal-title":"PloS one"},{"key":"pone.0271511.ref005","doi-asserted-by":"crossref","first-page":"e2017002","DOI":"10.4178\/epih.e2017002","article-title":"Prevalence of latent tuberculosis infection among tuberculosis laboratory workers in Iran.","volume":"39","author":"M Nasehi","year":"2017","journal-title":"Epidemiol Health"},{"issue":"5","key":"pone.0271511.ref006","doi-asserted-by":"crossref","first-page":"e7","DOI":"10.1016\/j.ajic.2015.01.020","article-title":"Lack of optimum practice among health care workers regarding tuberculosis in Iran: A knowledge, attitude, and practice study","volume":"43","author":"A Doosti Irani","year":"2015","journal-title":"American journal of infection control."},{"issue":"1","key":"pone.0271511.ref007","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1186\/s40249-019-0515-y","article-title":"Prevalence and risk factors of active pulmonary tuberculosis among elderly people in China: a population based cross-sectional study","volume":"8","author":"CY Zhang","year":"2019","journal-title":"Infect Dis Poverty"},{"key":"pone.0271511.ref008","doi-asserted-by":"crossref","first-page":"k757","DOI":"10.1136\/bmj.k757","article-title":"Population attributable fraction","volume":"360","author":"MA Mansournia","year":"2018","journal-title":"BMJ"},{"key":"pone.0271511.ref009","first-page":"50","article-title":"Population attributable fraction: planning of diseases prevention actions in Brazil","author":"LF Rezende","year":"2016","journal-title":"Revista de saude publica"},{"issue":"1","key":"pone.0271511.ref010","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1186\/s40249-019-0587-8","article-title":"Recommendation on unbiased estimation of population attributable fraction calculated in \u201cprevalence and risk factors of active pulmonary tuberculosis among elderly people in China: a population based cross-sectional study","volume":"8","author":"A Khosravi","year":"2019","journal-title":"Infectious Diseases of Poverty"},{"key":"pone.0271511.ref011","author":"Organization WH","year":"2014"},{"key":"pone.0271511.ref012","author":"GA Wells","year":"2000"},{"issue":"6","key":"pone.0271511.ref013","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1093\/heapol\/czl029","article-title":"Constructing socio-economic status indices: how to use principal components analysis","volume":"21","author":"S Vyas","year":"2006","journal-title":"Health policy and planning."},{"key":"pone.0271511.ref014","author":"M Szklo","year":"2014","edition":"4"},{"key":"pone.0271511.ref015","doi-asserted-by":"crossref","first-page":"100062","DOI":"10.1016\/j.gloepi.2021.100062","article-title":"Population attributable fraction in textbooks: Time to revise","volume":"3","author":"A Khosravi","year":"2021","journal-title":"Global Epidemiology."},{"issue":"3","key":"pone.0271511.ref016","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1177\/096228020101000303","article-title":"A review of adjusted estimators of attributable risk","volume":"10","author":"J. Benichou","year":"2001","journal-title":"Statistical Methods in Medical Research"},{"key":"pone.0271511.ref017","volume-title":"Major Infectious Diseases","author":"BR Bloom","year":"2017"},{"key":"pone.0271511.ref018","author":"National Immunization Committee","year":"2015","edition":"8"},{"key":"pone.0271511.ref019","unstructured":"World health organization. Iran (Islamic Republic of): WHO and UNICEF estimates of immunization coverage: 2019 revision [updated June 29, 2020]. 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