Diabetes mellitus and tuberculosis in countries with high tuberculosis burdens: individual risks and social determinants
Diabetes mellitus and tuberculosis in countries with high tuberculosis burdens: individual risks and social determinants
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DOI：
10.1093/ije/dyq238
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发表时间：
2011-04-01
影响因子：
7.7
通讯作者：
Murray, Megan B.
中科院分区：
文献类型：
--
作者：
Goldhaber-Fiebert, Jeremy D.;Jeon, Christie Y.;Murray, Megan B.
背景：越来越多的证据支持2型糖尿病是结核病(TB)的个体水平的危险因素，尽管缺乏来自结核病负担最高的发展中国家的证据。在发展中国家，结核病在穷人中最常见，而糖尿病在穷人中可能不太常见。我们在这些背景下评估了个人水平的风险、社会决定因素和人口健康之间的关系。方法我们使用世界健康调查(n=124 607；46个国家)进行个人水平的分析。我们估计了结核病和糖尿病之间的关系，调整了性别、年龄、体重指数、教育程度、住房质量、拥挤和医疗保险。我们还利用163个国家的人均国内生产总值、结核病患病率和发病率以及糖尿病患病率的数据进行了国家层面的纵向分析，以估计糖尿病患病率上升与结核病之间的关系，确定疾病相互作用的风险国家。结果在低收入国家，糖尿病患者比非糖尿病患者更容易患结核病[单变量优势比(OR)：2.39；95%可信区间(CI)：1.84-3.10；多变量OR：1.81；95%CI：1.37-2.39]。当糖尿病患病率也增加时(OR：4.7；95%CI：1.0-22.5；OR：8.6；95%CI：1.9-40.4)，随着时间的推移，结核病患病率和发病率更有可能增加。庞大的人口、流行的结核病和糖尿病的预计增加使印度、秘鲁和俄罗斯联邦等国家特别令人担忧。结论考虑到糖尿病与结核病之间的联系以及全球糖尿病预计增加的情况，应该考虑多种疾病的卫生政策。
Background A growing body of evidence supports the role of type 2 diabetes as an individual-level risk factor for tuberculosis (TB), though evidence from developing countries with the highest TB burdens is lacking. In developing countries, TB is most common among the poor, in whom diabetes may be less common. We assessed the relationship between individual-level risk, social determinants and population health in these settings.Methods We performed individual-level analyses using the World Health Survey (n = 124 607; 46 countries). We estimated the relationship between TB and diabetes, adjusting for gender, age, body mass index, education, housing quality, crowding and health insurance. We also performed a longitudinal country-level analysis using data on per-capita gross domestic product and TB prevalence and incidence and diabetes prevalence for 1990-95 and 2003-04 (163 countries) to estimate the relationship between increasing diabetes prevalence and TB, identifying countries at risk for disease interactions.Results In lower income countries, individuals with diabetes are more likely than non-diabetics to have TB [univariable odds ratio (OR): 2.39; 95% confidence interval (CI): 1.84-3.10; multivariable OR: 1.81; 95% CI: 1.37-2.39]. Increases in TB prevalence and incidence over time were more likely to occur when diabetes prevalence also increased (OR: 4.7; 95% CI: 1.0-22.5; OR: 8.6; 95% CI: 1.9-40.4). Large populations, prevalent TB and projected increases in diabetes make countries like India, Peru and the Russia Federation areas of particular concern.Conclusions Given the association between diabetes and TB and projected increases in diabetes worldwide, multi-disease health policies should be considered.