The Role of Tuberculosis Disease on Non-Communicable Disease Risk: Comparative Analysis of Large Healthcare Databases

项目总结 结核病(TB)与非传染性疾病(NCDs)的交叉，包括糖尿病， 肺部疾病和心血管疾病已成为一个严重的公共卫生问题。迅速地 不断扩大的非传染性疾病疫情威胁着低收入和中等收入国家的结核病控制，在这些国家，预防和治疗 结核病仍然是一个巨大的负担。然而，到目前为止，结核病可能会增加慢性病风险的概念 非传染性疾病还没有得到很好的探索。使用两个大型医疗保健数据库，我们将确定结核病的程度 增加结核病后糖尿病、肺部疾病和心血管疾病的风险。此二次数据 分析研究研究将促进对结核病和非传染性疾病多发病双重负担的理解，并建立 综合护理和预防非传染性疾病的知识库。 这项研究的总体目标是提高对结核病和结核病之间关系的理解 糖尿病、肺部疾病和心血管疾病的后续风险，并确定预防目标 这些非传染性疾病在结核病患者中的传播。这项建议的具体目标是：(1)确定结核病的程度 疾病增加了糖尿病、肺部疾病(哮喘和慢性阻塞性肺病)和 心血管疾病(缺血性中风、冠状动脉疾病、外周血管疾病和一过性 缺血性发作(TIA)，(2)确定生物性别、体重指数、艾滋病毒、种族/民族和结核病发病时年龄的程度 疾病改变和调节结核病与糖尿病、肺部疾病和 心血管疾病，以及(3)探讨预测早期非传染性疾病发病率的结核病临床特征(糖尿病的首次诊断， 肺部疾病，或结核病治愈后5年内的心血管疾病)。为了满足 根据研究的目的和目的，我们将利用两个具有良好特点和全面的医疗保健数据库。 首先，我们将使用美国退伍军人事务医疗保健中心的电子健康记录来组装 关于诊断代码、处方药使用、住院和生命状态的可比数据。第二，我们 将使用临床实践研究数据链，这是英国初级保健患者的数据库， 具有全国代表性，并与入院和死亡数据相联系。拟议的方法将允许 美国召集了16,000名结核病幸存者，并对他们进行了平均6.5年的跟踪调查。然后我们将比较 64,000名年龄、性别和种族/民族的结核病幸存者的非传染性疾病发病率与没有结核病病史的对照组相匹配。 拟议的研究将重要地描述结核病在多大程度上导致结核病后非传染性疾病多发病。 两个大型医疗机构对结核病后结果的比较将极大地增强我们结果的有效性 并提高根据我们的发现提出因果推断的能力。拟议工作的长期目标 是为评估结核病治疗期间非传染性疾病预防方法的前瞻性干预研究做准备 并在结核病治疗几年后确定其疗效。

PROJECT SUMMARY The intersection of tuberculosis (TB) disease with non-communicable diseases (NCDs), including diabetes mellitus, pulmonary disease, and cardiovascular disease, has emerged as a critical public health concern. Rapidly expanding NCD epidemics threaten TB control in low- and middle-income countries, where preventing and treating TB disease remains a great burden. However, to date, the notion that TB disease may increase the risk of chronic NCDs has not been well explored. Using two large healthcare databases, we will determine the extent that TB increases the risk of post-TB diabetes, pulmonary disease, and cardiovascular disease. This secondary data analysis research study will advance understanding of dual burdens of TB and NCD multimorbidity and build a knowledge base for integrated care and prevention of NCDs. The overall objective of this study is to improve understanding of the relationship between TB disease and subsequent risks of diabetes, pulmonary disease, and cardiovascular disease, and to identify targets for preventing these NCDs among TB patients. The specific aims of this proposal are to: (1) determine the extent to which TB disease increases the risk of future development of diabetes mellitus, pulmonary disease (asthma and COPD) and cardiovascular disease (ischemic stroke, coronary artery disease, peripheral vascular disease, and transient ischemic attack TIA), (2) determine the extent to biologic sex, BMI, HIV, race/ethnicity, and age at time of TB disease modify and mediate the relationships between TB and incidence of diabetes, pulmonary disease, and CVD, and (3) explore TB clinical characteristics that predict early NCD incidence (a first diagnosis of diabetes, pulmonary diseases, or CVD within 5 years after TB cure) among patients with previous TB disease. To meet the study’s objectives and aims, we will leverage two well-characterized and comprehensive health care databases. First, we will use electronic health records from the US Veterans Affairs Medical Care Centers to assemble comparable data on diagnostic codes, prescription medication use, hospitalization, and vital status. Second, we will use the Clinical Practice Research Datalink, a database of primary care patients in the United Kingdom that is nationally representative and linked to hospital admissions and mortality data. The proposed approach will allow us to assemble a cohort of >16,000 TB survivors and follow them for an average of 6.5 years. We will then compare NCD incidence among TB survivors to >64,000 age, sex, and race/ethnicity matched controls without previous TB. The proposed study will importantly characterize the extent to which TB contributes to post-TB NCD multimorbidity. The comparison of post-TB outcomes across two large health care will greatly strengthen the validity of our results and increase the ability to suggest causal inferences based on our findings. A long-term goal of the proposed work is to prepare for prospective interventional studies that evaluate NCD prevention approaches during TB treatment and determine their efficacy several years after TB treatment.