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

项目摘要 结核病与包括糖尿病在内的非传染性疾病相互交织， 肺疾病和心血管疾病已经成为关键的公共卫生问题。迅速 不断扩大的非传染性疾病流行威胁着中低收入国家的结核病控制， 结核病仍然是一个巨大的负担。然而，迄今为止，结核病可能增加慢性结核病风险的观点， 非传染性疾病尚未得到充分探讨。使用两个大型医疗保健数据库，我们将确定结核病 增加结核病后糖尿病、肺部疾病和心血管疾病的风险。这些次要数据 分析研究将促进对结核病和非传染性疾病多重负担的理解， 为综合护理和预防非传染性疾病建立知识基础。 本研究的总体目标是提高对结核病与 糖尿病、肺病和心血管疾病的后续风险，并确定预防目标 这些非传染性疾病的发病率。该提案的具体目标是：（1）确定结核病的程度 疾病会增加未来发生糖尿病、肺部疾病（哮喘和COPD）的风险， 心血管疾病（缺血性中风、冠状动脉疾病、外周血管疾病和短暂性 缺血性发作TIA），（2）确定TB发生时的生物学性别、BMI、HIV、人种/种族和年龄的程度 疾病改变和介导结核病与糖尿病、肺病和 CVD，和（3）探索预测早期NCD发病率的TB临床特征（糖尿病的首次诊断， 肺疾病，或心血管疾病后5年内治愈结核病）与以前的结核病患者。满足 研究的目的和目标，我们将利用两个良好的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， 诊断代码、处方药使用、住院和生命状态的可比数据。二是 将使用临床实践研究数据链，这是一个英国初级保健患者的数据库， 具有全国代表性，并与住院和死亡率数据相关联。拟议的办法将允许 我们收集了一组> 16，000名结核病幸存者，并对他们进行了平均6.5年的随访。我们将比较 结核病幸存者与> 64，000名年龄、性别和种族/民族匹配的对照组（既往无结核病）的NCD发病率。 拟议的研究将重要地描述结核病在结核病后非传染性疾病多重发病中的作用程度。 两个大型医疗机构结核病后结果的比较将大大加强我们结果的有效性 并提高根据我们的发现提出因果推论的能力。拟议工作的长期目标 是为评估结核病治疗期间NCD预防方法的前瞻性干预性研究做准备 并在结核病治疗数年后确定其疗效。

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.