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Observational Study
. 2022 May 23:10:789952.
doi: 10.3389/fpubh.2022.789952. eCollection 2022.

Subjects With Diabetes Mellitus Are at Increased Risk for Developing Tuberculosis: A Cohort Study in an Inner-City District of Barcelona (Spain)

Violeta Antonio-Arques  1   2 , Josep Franch-Nadal  1   3   4 , Antonio Moreno-Martinez  5   6 , Jordi Real  1   4 , Àngels Orcau  6   7 , Didac Mauricio  1   4   8   9 , Manel Mata-Cases  1   4   10 , Josep Julve  4   11 , Elena Navas Mendez  12 , Rai Puig Treserra  1 , Joan Barrot de la Puente  1   13 , Joan Pau Millet  6   7 , Jose Luis Del Val García  12   14 , Bogdan Vlacho  1 , Joan A Caylà  15
Affiliations
Observational Study

Subjects With Diabetes Mellitus Are at Increased Risk for Developing Tuberculosis: A Cohort Study in an Inner-City District of Barcelona (Spain)

Violeta Antonio-Arques et al. Front Public Health. .

Abstract

Background: Tuberculosis is the leading cause of mortality from lung infectious disease worldwide in recent years, and its incidence has re-emerged in large cities in low-incidence countries due to migration and socioeconomic deprivation causes. Diabetes mellitus and tuberculosis are syndemic diseases, with diabetes being considered a risk factor for developing tuberculosis.

Objective: To investigate whether diabetic patients were at increased risk of tuberculosis living in an inner-district of a large city of northeastern Spain.

Methods: Observational matched retrospective cohort study based on clinical records from the population of the lowest socioeconomic status in Barcelona (Ciutat Vella district). A cohort including patients with type 1 and type 2 diabetes mellitus in 2007 and new cases until 2016 (8004 subjects), matched 1:1 by sex and age with a non-diabetic cohort. Follow-up period was until December 31st 2018. We evaluated the risk of developing tuberculosis in diabetic patients compared to non-diabetic patients during the follow up period. We used time-to-event analysis to estimate the incidence of tuberculosis, and competing risks regression by clusters and conditional Cox regression models to calculate the hazard ratio (HR) and its 95% confidence intervals (CI).

Results: Among the 16,008 included subjects, the median follow-up was 8.7 years. The mean age was 57.7 years; 61.2% men and 38.8% women in both groups. The incidence of tuberculosis was 69.9 per 100,000 person-years in diabetic patients, and 40.9 per 100,000 person-years in non-diabetic patients (HR = 1.90; CI: 1.18-3.07). After adjustment for the country of origin, chronic kidney disease, number of medical appointments, BMI, alcoholism and smoking, the risk remained higher in diabetic patients (1.66: CI 0.99-2.77). Additionally, subjects from Hindustan or with a history of alcohol abuse also showed a higher risk of developing tuberculosis (HR = 3.51; CI:1.87-6.57, and HR = 2.73; CI:1.22-6.12 respectively).

Conclusion: People with diabetes mellitus were at higher risk of developing tuberculosis in a large cohort recruited in an inner-city district with a high incidence for this outcome, and low socioeconomic conditions and high proportion of migrants. This risk was higher among Hindustan born and alcohol abusers.

Keywords: Mycobacterium tuberculosis infection; alcohol abuse; diabetes complications; diabetes mellitus; incidence; tuberculosis.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Sampling and follow-up scheme: an example of s pairs of individuals by age and sex.
Figure 2
Figure 2
Flow chart of the cohorts within the study population.
Figure 3
Figure 3
Incidence of tuberculosis in diabetic and non-diabetic patients.
Figure 4
Figure 4
Forest plot of HR of each TB risk factor in the multivariate model.
See this image and copyright information in PMC

References

    1. World Health Organization . Global Tuberculosis Report 2021. Available online at: https://www.who.int/teams/global-tuberculosis-programme/tb-reports/globa... (accessed May 15, 2021).
    1. de Vries G, Aldridge RW, Caylã JA, Haas WH, Sandgren A, van Hest NA, et al. Epidemiology of tuberculosis in big cities of the European union and European economic area countries. Eurosurveillance. (2014) 19:1–8. 10.2807/1560-7917.ES2014.19.9.20726 - DOI - PubMed
    1. Khan K, Hirji M, Miniota J, Hu W, Wang J, Gardam M, et al. Domestic impact of tuberculosis screening among new immigrants to Ontario, Canada. CMAJ. (2018) 187:473–81. 10.1503/cmaj.150011 - DOI - PMC - PubMed
    1. Millet JP, Moreno A, Fina L, Baño L., Del, Orcau A, De Olalla PG, et al. Factors that influence current tuberculosis epidemiology. Eur Spine J. (2013) 22:8. 10.1007/s00586-012-2334-8 - DOI - PMC - PubMed
    1. van Hest NA, Aldridge RW, de Vries G, Sandgren A, Hauer B, Hayward A, et al. Tuberculosis control in big cities and urban risk groups in the European Union: a consensus statement. Eurosurveillance [Internet]. (2014) 19:1–13. 10.2807/1560-7917.ES2014.19.9.20728 - DOI - PubMed

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