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

Frontiers in Public Health

Manel Mata-Cases¹  Josep Julve²  Elena Navas Mendez³  Joan Barrot de la Puente⁴  Jose Luis Del Val García⁵  Joan A. Caylà⁶  Josep Franch-Nadal⁷  Jordi Real⁷  Antonio Moreno-Martinez⁸  Rai Puig Treserra⁹  Bogdan Vlacho⁹  Didac Mauricio^1,12  Àngels Orcau^1,13  Joan Pau Millet^1,13  Violeta Antonio-Arques^1,14 

[1] 0Primary Health Care Center La Mina, Gerència d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain;1Department of Biochemistry, Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, Barcelona, Spain;2Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain;3Primary Health Care Center Doctor Jordi Nadal, Gerència d'Atenció Primària Girona Ciutat, Institut Catala de la Salut, Salt, Spain;4Unitat d'Avaluació, Sistemes d'informació i Qualitat, Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain;5Foundation of the Tuberculosis Research Unit of Barcelona, Barcelona, Spain;CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain;CIBER of Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain;DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain;Department of Endocrinology and Nutrition, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain;Department of Infectious Diseases, Hospital Clínic de Barcelona, Barcelona, Spain;Department of Medicine, University of Vic—Central University of Catalonia, Barcelona, Spain;Epidemiology Service, Agència de Salut Pública de Barcelona, Barcelona, Spain;Primary Health Care Center Bordeta Magòria, Gerència d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain;Primary Health Care Center Raval Sud, Gerència d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain;

关键词: diabetes mellitus;    tuberculosis;    incidence;    diabetes complications;    Mycobacterium tuberculosis infection;    alcohol abuse;   

DOI  :  10.3389/fpubh.2022.789952

来源: DOAJ

【 摘 要 】

BackgroundTuberculosis 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.ObjectiveTo investigate whether diabetic patients were at increased risk of tuberculosis living in an inner-district of a large city of northeastern Spain.MethodsObservational 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).ResultsAmong 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).ConclusionPeople 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.

【 授权许可】

Unknown