Subjects With Diabetes Mellitus Are at Increased Risk for Developing Tuberculosis: A Cohort Study in an Inner-City District of Barcelona (Spain)
Por:
Antonio-Arques, V, Franch-Nadal, J, Moreno-Martinez, A, Real, J, Orcau, A, Mauricio, D, Mata-Cases, M, Julve, J, Mendez, EN, Treserra, RP, de la Puente, JB, Millet, JP, Garcia, JLD, Vlacho, B, Cayla, JA
Publicada:
23 may 2022
Resumen:
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.
Filiaciones:
Antonio-Arques, V:
Fundacio Inst Univ Recerca Atencio Primaria Salut, Cat Grp, DAP, Unitat Suport Recerca Barcelona, Barcelona, Spain
Inst Catala Salut, Primary Hlth Care Ctr Bordeta Magoria, Gerencia Atencio Primaria Barcelona Ciutat, Barcelona, Spain
Franch-Nadal, J:
Fundacio Inst Univ Recerca Atencio Primaria Salut, Cat Grp, DAP, Unitat Suport Recerca Barcelona, Barcelona, Spain
Inst Catala Salut, Primary Hlth Care Ctr Raval Sud, Gerencia Atencio Primaria Barcelona Ciutat, Barcelona, Spain
Inst Salud Carlos III ISCIII, CIBER Diabet & Associated Metab Dis CIBERDEM, Madrid, Spain
Moreno-Martinez, A:
Hosp Clin Barcelona, Dept Infect Dis, Barcelona, Spain
Inst Salud Carlos III ISCIII, CIBER Epidemiol & Publ Hlth CIBERESP, Madrid, Spain
Real, J:
Fundacio Inst Univ Recerca Atencio Primaria Salut, Cat Grp, DAP, Unitat Suport Recerca Barcelona, Barcelona, Spain
Inst Salud Carlos III ISCIII, CIBER Diabet & Associated Metab Dis CIBERDEM, Madrid, Spain
Orcau, A:
Inst Salud Carlos III ISCIII, CIBER Epidemiol & Publ Hlth CIBERESP, Madrid, Spain
Agencia Salut Publ Barcelona, Epidemiol Serv, Barcelona, Spain
Mauricio, D:
Fundacio Inst Univ Recerca Atencio Primaria Salut, Cat Grp, DAP, Unitat Suport Recerca Barcelona, Barcelona, Spain
Inst Salud Carlos III ISCIII, CIBER Diabet & Associated Metab Dis CIBERDEM, Madrid, Spain
Hosp Universitari Santa Creu & Santa Pau, Dept Endocrinol & Nutr, Barcelona, Spain
Univ Vic, Cent Univ Catalonia, Dept Med, Barcelona, Spain
Mata-Cases, M:
Fundacio Inst Univ Recerca Atencio Primaria Salut, Cat Grp, DAP, Unitat Suport Recerca Barcelona, Barcelona, Spain
Inst Salud Carlos III ISCIII, CIBER Diabet & Associated Metab Dis CIBERDEM, Madrid, Spain
Inst Catala Salut, Primary Hlth Care Ctr Mina, Gerencia Atencio Primaria Barcelona Ciutat, Barcelona, Spain
Julve, J:
Inst Salud Carlos III ISCIII, CIBER Diabet & Associated Metab Dis CIBERDEM, Madrid, Spain
Inst Recerca lHospital Santa Creu & Santa Pau, Dept Biochem, Barcelona, Spain
Mendez, EN:
Fundacio Inst Universitari Recerca Atencio Primari, Barcelona, Spain
Treserra, RP:
Fundacio Inst Univ Recerca Atencio Primaria Salut, Cat Grp, DAP, Unitat Suport Recerca Barcelona, Barcelona, Spain
de la Puente, JB:
Fundacio Inst Univ Recerca Atencio Primaria Salut, Cat Grp, DAP, Unitat Suport Recerca Barcelona, Barcelona, Spain
Inst Catala Salut, Primary Hlth Care Ctr Doctor Jordi Nadal, Gerencia Atencio Primaria Girona Ciutat, Salt, Spain
Millet, JP:
Inst Salud Carlos III ISCIII, CIBER Epidemiol & Publ Hlth CIBERESP, Madrid, Spain
Agencia Salut Publ Barcelona, Epidemiol Serv, Barcelona, Spain
Garcia, JLD:
Fundacio Inst Universitari Recerca Atencio Primari, Barcelona, Spain
Inst Catala Salut, Unitat Avaluacio, Sistemes Informacio & Qualitat, Gerencia Ambit Atencio Primaria Barcelona Ciutat, Barcelona, Spain
Vlacho, B:
Fundacio Inst Univ Recerca Atencio Primaria Salut, Cat Grp, DAP, Unitat Suport Recerca Barcelona, Barcelona, Spain
Cayla, JA:
Fdn TB Res Unit Barcelona, Barcelona, Spain
Green Published, gold, All Open Access, Gold, Green
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