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

项目概要 结核病 (TB) 与非传染性疾病 (NCD) 的交集，包括糖尿病、 肺部疾病和心血管疾病已成为重要的公共卫生问题。迅速 不断扩大的非传染性疾病流行威胁着低收入和中等收入国家的结核病控制，这些国家的结核病预防和治疗工作 结核病仍然是一个巨大的负担。然而，迄今为止，人们认为结核病可能会增加慢性病的风险。 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，我们将确定结核病的严重程度 增加患结核病后糖尿病、肺部疾病和心血管疾病的风险。这个二手数据 分析研究将增进对结核病和非传染性疾病多重发病率双重负担的理解，并建立一个 非传染性疾病综合护理和预防知识库。 本研究的总体目标是提高对结核病与结核病之间关系的认识。 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 结核病患者中的这些非传染性疾病。该提案的具体目标是：(1) 确定结核病的严重程度 疾病会增加未来患糖尿病、肺部疾病（哮喘和慢性阻塞性肺病）的风险 心血管疾病（缺血性中风、冠状动脉疾病、周围血管疾病和短暂性血管疾病） 缺血性发作 TIA), (2) 确定结核病发生时的生物性别、BMI、HIV、种族/民族和年龄的程度 疾病改变和调节结核病与糖尿病、肺病和糖尿病发病率之间的关系 CVD，以及 (3) 探索预测早期 NCD 发病率的结核病临床特征（首次诊断为糖尿病、 患有既往结核病的患者中的肺部疾病，或结核病治愈后 5 年内的 CVD）。为了满足 为了实现研究的目的和目标，我们将利用两个特征明确且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部医疗保健中心的电子健康记录来收集 有关诊断代码、处方药使用、住院情况和生命状况的可比数据。第二，我们 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入院和死亡率数据相关。拟议的方法将允许 我们收集了超过 16,000 名结核病幸存者的队列，并对他们进行平均 6.5 年的跟踪。然后我们将比较 结核病幸存者中的非传染性疾病发病率超过 64,000 名，其年龄、性别和种族/族裔与没有既往结核病的对照相匹配。 拟议的研究将重要地描述结核病对结核病后非传染性疾病多发病的影响程度。 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.