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Silva Júnior JNDB, Couto RDM, Alves LC, da Silva DA, Heráclio IDL, Pelissari DM, Andrade KB, Oliveira PB. Trends in tuberculosis incidence and mortality coefficients in Brazil, 2011-2019: analysis by inflection points. Rev Panam Salud Publica 2023; 47:e152. [PMID: 37937313 PMCID: PMC10627430 DOI: 10.26633/rpsp.2023.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/17/2023] [Indexed: 11/09/2023] Open
Abstract
Objective To analyze the temporal trend of tuberculosis incidence and mortality rates in Brazil between 2011 and 2019. Methods This was an ecological time series study of tuberculosis incidence and mortality rates in Brazil between 2011 and 2019. Data were extracted from the Notifiable Disease Information System and the Mortality Information System, and population estimates were from the Brazilian Institute of Geography and Statistics. Trends were analyzed by Joinpoint regression, which recognizes inflection points for temporal analysis. Results The average incidence rate of tuberculosis in Brazil in the period was 35.8 cases per 100 000 population. From 2011 to 2015, this coefficient had an annual percentage change of -1.9% (95% CI [-3.4, -0.5]) followed by an increase of 2.4% (95% CI [0.9, 3.9]) until 2019. The average mortality rate between 2011 and 2019 was 2.2 deaths per 100 000 population, with an average annual percentage change of -0.4% (95% CI [-1.0, 0.2]). Amazonas was the only state with an increase in the annual average percentage variation for the incidence rate (3.2%; 95% CI [1.3, 5.1]) and mortality rate (2.7%; 95% CI [1.0, 4.4]) over the years, while Rio de Janeiro state had an increasing inflection for incidence from 2014 to 2019 (2.4%; 95% CI [1.4, 3.5]) and annual average of decreasing percentage variation (-3.5%; 95% CI [-5.0, -1.9]). Conclusions During the period analyzed, a decreasing trend in incidence was observed between 2011 and 2015, and an increasing trend for the period from 2015 to 2019. On the other hand, no change in the trend for mortality was found in Brazil.
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Affiliation(s)
- José Nildo de Barros Silva Júnior
- Secretaria de Vigilância em SaúdeMinistry of HealthBrasília, DFBrazilSecretaria de Vigilância em Saúde, Ministry of Health, Brasília, DF, Brazil
| | - Rodrigo de Macedo Couto
- Secretaria de Vigilância em SaúdeMinistry of HealthBrasília, DFBrazilSecretaria de Vigilância em Saúde, Ministry of Health, Brasília, DF, Brazil
| | - Layana Costa Alves
- Secretaria de Vigilância em SaúdeMinistry of HealthBrasília, DFBrazilSecretaria de Vigilância em Saúde, Ministry of Health, Brasília, DF, Brazil
| | - Daiane Alves da Silva
- Secretaria de Vigilância em SaúdeMinistry of HealthBrasília, DFBrazilSecretaria de Vigilância em Saúde, Ministry of Health, Brasília, DF, Brazil
| | - Isabela de Lucena Heráclio
- Secretaria de Vigilância em SaúdeMinistry of HealthBrasília, DFBrazilSecretaria de Vigilância em Saúde, Ministry of Health, Brasília, DF, Brazil
| | - Daniele Maria Pelissari
- Secretaria de Vigilância em SaúdeMinistry of HealthBrasília, DFBrazilSecretaria de Vigilância em Saúde, Ministry of Health, Brasília, DF, Brazil
| | - Kleydson Bonfim Andrade
- Pan American Health OrganizationBrasília, DFBrazilPan American Health Organization, Brasília, DF, Brazil
| | - Patrícia Bartholomay Oliveira
- Secretaria de Vigilância em SaúdeMinistry of HealthBrasília, DFBrazilSecretaria de Vigilância em Saúde, Ministry of Health, Brasília, DF, Brazil
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Kim HH, Kim S, Kim MA, Jung CH, Chong YP, Shim TS, Kim YJ, Jo KW. Stratification of Nontuberculous Mycobacterial Disease Risk in Type 2 Diabetes Based on Metformin Use: a Population-Based Cohort Study in South Korea. Antimicrob Agents Chemother 2023; 67:e0167522. [PMID: 37222618 PMCID: PMC10269046 DOI: 10.1128/aac.01675-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 05/12/2023] [Indexed: 05/25/2023] Open
Abstract
In a 1:4 case-control matched analysis of data from a nationwide population-based cohort in South Korea, we evaluated whether metformin use mitigates the risk of nontuberculous mycobacterial disease in patients with type 2 diabetes. Multivariable analysis revealed no significant association of metformin use with a diminished risk for incident nontuberculous mycobacterial disease in patients with type 2 diabetes.
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Affiliation(s)
- Hyeon Hwa Kim
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seonok Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Mi Ae Kim
- Department of Internal Medicine, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Chang Hee Jung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yong Pil Chong
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Tae Sun Shim
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ye-Jee Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kyung-Wook Jo
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Sex differences in the impact of diabetes mellitus on tuberculosis recurrence: a retrospective national cohort study. Int J Infect Dis 2023; 127:1-10. [PMID: 36464121 DOI: 10.1016/j.ijid.2022.11.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/15/2022] [Accepted: 11/25/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES Whether diabetes mellitus (DM) increases tuberculosis (TB) recurrence risk is debatable. We determined the effect of DM on TB recurrence. METHODS This retrospective nationwide cohort study included patients with TB who successfully completed TB treatment during 2011-2017 and were followed up for TB recurrence until August 2020. We performed subdistribution hazard model analyses stratified by sex to assess DM risk related to TB recurrence after successful treatment. RESULTS Of 199,571 participants who had received successful TB treatment, 47,952 (24%) had DM. There were more men (64.4%), positive acid-fast bacilli smears (35.9%), and positive cultures (49.5%) in the DM group. There were 6208 (3.1%) TB recurrences during 5.1 years of follow-up: 38.9% and 26.6% occurred 1 and 1-2 years after treatment completion, respectively. The recurrence rate was higher in the DM group (3.8%) than in the non-DM group (2.9%, P <0.0001). DM was associated with a higher TB recurrence risk, especially in men (adjusted hazard ratio 1.23, 95% confidence interval 1.15-1.32) but not in women (adjusted hazard ratio 0.96, 95% confidence interval 0.85-1.09). CONCLUSION The TB recurrence rate after successful treatment was higher in patients with DM than in patients without DM. DM is associated with TB recurrence in men.
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Ledesma JR, Ma J, Vongpradith A, Maddison ER, Novotney A, Biehl MH, LeGrand KE, Ross JM, Jahagirdar D, Bryazka D, Feldman R, Abolhassani H, Abosetugn AE, Abu-Gharbieh E, Adebayo OM, Adnani QES, Afzal S, Ahinkorah BO, Ahmad SA, Ahmadi S, Ahmed Rashid T, Ahmed Salih Y, Aklilu A, Akunna CJ, Al Hamad H, Alahdab F, Alemayehu Y, Alene KA, Ali BA, Ali L, Alipour V, Alizade H, Al-Raddadi RM, Alvis-Guzman N, Amini S, Amit AML, Anderson JA, Androudi S, Antonio CAT, Antony CM, Anwer R, Arabloo J, Arja A, Asemahagn MA, Atre SR, Azhar GS, B DB, Babar ZUD, Baig AA, Banach M, Barqawi HJ, Barra F, Barrow A, Basu S, Belgaumi UI, Bhagavathula AS, Bhardwaj N, Bhardwaj P, Bhattacharjee NV, Bhattacharyya K, Bijani A, Bikbov B, Boloor A, Briko NI, Buonsenso D, Burugina Nagaraja S, Butt ZA, Carter A, Carvalho F, Charan J, Chatterjee S, Chattu SK, Chattu VK, Christopher DJ, Chu DT, Claassens MM, Dadras O, Dagnew AB, Dai X, Dandona L, Dandona R, Daneshpajouhnejad P, Darwesh AM, Dhamnetiya D, Dianatinasab M, Diaz D, Doan LP, Eftekharzadeh S, Elhadi M, Emami A, Enany S, Faraon EJA, Farzadfar F, Fernandes E, Ferro Desideri L, Filip I, Fischer F, Foroutan M, Frank TD, Garcia-Basteiro AL, Garcia-Calavaro C, Garg T, Geberemariyam BS, Ghadiri K, Ghashghaee A, Golechha M, Goodridge A, Gupta B, Gupta S, Gupta VB, Gupta VK, Haider MR, Hamidi S, Hanif A, Haque S, Harapan H, Hargono A, Hasaballah AI, Hashi A, Hassan S, Hassankhani H, Hayat K, Hezam K, Holla R, Hosseinzadeh M, Hostiuc M, Househ M, Hussain R, Ibitoye SE, Ilic IM, Ilic MD, Irvani SSN, Ismail NE, Itumalla R, Jaafari J, Jacobsen KH, Jain V, Javanmardi F, Jayapal SK, Jayaram S, Jha RP, Jonas JB, Joseph N, Joukar F, Kabir Z, Kamath A, Kanchan T, Kandel H, Katoto PDMC, Kayode GA, Kendrick PJ, Kerbo AA, Khajuria H, Khalilov R, Khatab K, Khoja AT, Khubchandani J, Kim MS, Kim YJ, Kisa A, Kisa S, Kosen S, Koul PA, Koulmane Laxminarayana SL, Koyanagi A, Krishan K, Kucuk Bicer B, Kumar A, Kumar GA, Kumar N, Kumar N, Kwarteng A, Lak HM, Lal DK, Landires I, Lasrado S, Lee SWH, Lee WC, Lin C, Liu X, Lopukhov PD, Lozano R, Machado DB, Madhava Kunjathur S, Madi D, Mahajan PB, Majeed A, Malik AA, Martins-Melo FR, Mehta S, Memish ZA, Mendoza W, Menezes RG, Merie HE, Mersha AG, Mesregah MK, Mestrovic T, Mheidly NM, Misra S, Mithra P, Moghadaszadeh M, Mohammadi M, Mohammadian-Hafshejani A, Mohammed S, Molokhia M, Moni MA, Montasir AA, Moore CE, Nagarajan AJ, Nair S, Nair S, Naqvi AA, Narasimha Swamy S, Nayak BP, Nazari J, Neupane Kandel S, Nguyen TH, Nixon MR, Nnaji CA, Ntsekhe M, Nuñez-Samudio V, Oancea B, Odukoya OO, Olagunju AT, Oren E, P A M, Parthasarathi R, Pashazadeh Kan F, Pattanshetty SM, Paudel R, Paul P, Pawar S, Pepito VCF, Perico N, Pirestani M, Polibin RV, Postma MJ, Pourshams A, Prashant A, Pribadi DRA, Radfar A, Rafiei A, Rahim F, Rahimi-Movaghar V, Rahman M, Rahman M, Rahmani AM, Ranasinghe P, Rao CR, Rawaf DL, Rawaf S, Reitsma MB, Remuzzi G, Renzaho AMN, Reta MA, Rezaei N, Rezahosseini O, Rezai MS, Rezapour A, Roshandel G, Roshchin DO, Sabour S, Saif-Ur-Rahman KM, Salam N, Samadi Kafil H, Samaei M, Samy AM, Saroshe S, Sartorius B, Sathian B, Sawyer SM, Senthilkumaran S, Seylani A, Shafaat O, Shaikh MA, Sharafi K, Shetty RS, Shigematsu M, Shin JI, Silva JP, Singh JK, Sinha S, Skryabin VY, Skryabina AA, Spurlock EE, Sreeramareddy CT, Steiropoulos P, Sufiyan MB, Tabuchi T, Tadesse EG, Tamir Z, Tarkang EE, Tekalegn Y, Tesfay FH, Tessema B, Thapar R, Tleyjeh II, Tobe-Gai R, Tran BX, Tsegaye B, Tsegaye GW, Ullah A, Umeokonkwo CD, Valadan Tahbaz S, Vo B, Vu GT, Waheed Y, Walters MK, Whisnant JL, Woldekidan MA, Wubishet BL, Yahyazadeh Jabbari SH, Yazie TSY, Yeshaw Y, Yi S, Yiğit V, Yonemoto N, Yu C, Yunusa I, Zastrozhin MS, Zastrozhina A, Zhang ZJ, Zumla A, Mokdad AH, Salomon JA, Reiner Jr RC, Lim SS, Naghavi M, Vos T, Hay SI, Murray CJL, Kyu HH. Global, regional, and national sex differences in the global burden of tuberculosis by HIV status, 1990-2019: results from the Global Burden of Disease Study 2019. THE LANCET. INFECTIOUS DISEASES 2022; 22:222-241. [PMID: 34563275 PMCID: PMC8799634 DOI: 10.1016/s1473-3099(21)00449-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/21/2021] [Accepted: 07/15/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Tuberculosis is a major contributor to the global burden of disease, causing more than a million deaths annually. Given an emphasis on equity in access to diagnosis and treatment of tuberculosis in global health targets, evaluations of differences in tuberculosis burden by sex are crucial. We aimed to assess the levels and trends of the global burden of tuberculosis, with an emphasis on investigating differences in sex by HIV status for 204 countries and territories from 1990 to 2019. METHODS We used a Bayesian hierarchical Cause of Death Ensemble model (CODEm) platform to analyse 21 505 site-years of vital registration data, 705 site-years of verbal autopsy data, 825 site-years of sample-based vital registration data, and 680 site-years of mortality surveillance data to estimate mortality due to tuberculosis among HIV-negative individuals. We used a population attributable fraction approach to estimate mortality related to HIV and tuberculosis coinfection. A compartmental meta-regression tool (DisMod-MR 2.1) was then used to synthesise all available data sources, including prevalence surveys, annual case notifications, population-based tuberculin surveys, and tuberculosis cause-specific mortality, to produce estimates of incidence, prevalence, and mortality that were internally consistent. We further estimated the fraction of tuberculosis mortality that is attributable to independent effects of risk factors, including smoking, alcohol use, and diabetes, for HIV-negative individuals. For individuals with HIV and tuberculosis coinfection, we assessed mortality attributable to HIV risk factors including unsafe sex, intimate partner violence (only estimated among females), and injection drug use. We present 95% uncertainty intervals for all estimates. FINDINGS Globally, in 2019, among HIV-negative individuals, there were 1·18 million (95% uncertainty interval 1·08-1·29) deaths due to tuberculosis and 8·50 million (7·45-9·73) incident cases of tuberculosis. Among HIV-positive individuals, there were 217 000 (153 000-279 000) deaths due to tuberculosis and 1·15 million (1·01-1·32) incident cases in 2019. More deaths and incident cases occurred in males than in females among HIV-negative individuals globally in 2019, with 342 000 (234 000-425 000) more deaths and 1·01 million (0·82-1·23) more incident cases in males than in females. Among HIV-positive individuals, 6250 (1820-11 400) more deaths and 81 100 (63 300-100 000) more incident cases occurred among females than among males in 2019. Age-standardised mortality rates among HIV-negative males were more than two times greater in 105 countries and age-standardised incidence rates were more than 1·5 times greater in 74 countries than among HIV-negative females in 2019. The fraction of global tuberculosis deaths among HIV-negative individuals attributable to alcohol use, smoking, and diabetes was 4·27 (3·69-5·02), 6·17 (5·48-7·02), and 1·17 (1·07-1·28) times higher, respectively, among males than among females in 2019. Among individuals with HIV and tuberculosis coinfection, the fraction of mortality attributable to injection drug use was 2·23 (2·03-2·44) times greater among males than females, whereas the fraction due to unsafe sex was 1·06 (1·05-1·08) times greater among females than males. INTERPRETATION As countries refine national tuberculosis programmes and strategies to end the tuberculosis epidemic, the excess burden experienced by males is important. Interventions are needed to actively communicate, especially to men, the importance of early diagnosis and treatment. These interventions should occur in parallel with efforts to minimise excess HIV burden among women in the highest HIV burden countries that are contributing to excess HIV and tuberculosis coinfection burden for females. Placing a focus on tuberculosis burden among HIV-negative males and HIV and tuberculosis coinfection among females might help to diminish the overall burden of tuberculosis. This strategy will be crucial in reaching both equity and burden targets outlined by global health milestones. FUNDING Bill & Melinda Gates Foundation.
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Foe-Essomba JR, Kenmoe S, Tchatchouang S, Ebogo-Belobo JT, Mbaga DS, Kengne-Ndé C, Mahamat G, Kame-Ngasse GI, Noura EA, Mbongue Mikangue CA, Feudjio AF, Taya-Fokou JB, Touangnou-Chamda SA, Nayang-Mundo RA, Nyebe I, Magoudjou-Pekam JN, Yéngué JF, Djukouo LG, Demeni Emoh CP, Tazokong HR, Bowo-Ngandji A, Lontchi-Yimagou E, Kaiyven AL, Donkeng Donfack VF, Njouom R, Mbanya JC, Mbacham WF, Eyangoh S. Diabetes mellitus and tuberculosis, a systematic review and meta-analysis with sensitivity analysis for studies comparable for confounders. PLoS One 2021; 16:e0261246. [PMID: 34890419 PMCID: PMC8664214 DOI: 10.1371/journal.pone.0261246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 11/28/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction Meta-analyses conducted so far on the association between diabetes mellitus (DM) and the tuberculosis (TB) development risk did not sufficiently take confounders into account in their estimates. The objective of this systematic review was to determine whether DM is associated with an increased risk of developing TB with a sensitivity analyses incorporating a wider range of confounders including age, gender, alcohol consumption, smoke exposure, and other comorbidities. Methods Pubmed, Embase, Web of Science and Global Index Medicus were queried from inception until October 2020. Without any restriction to time of study, geographical location, and DM and TB diagnosis approaches, all observational studies that presented data for associations between DM and TB were included. Studies with no abstract or complete text, duplicates, and studies with wrong designs (review, case report, case series, comment on an article, and editorial) or populations were excluded. The odds ratios (OR) and their 95% confidence intervals were estimated by a random-effect model. Results The electronic and manual searches yielded 12,796 articles of which 47 were used in our study (23 case control, 14 cross-sectional and 10 cohort studies) involving 503,760 cases (DM or TB patients) and 3,596,845 controls. The size of the combined effect of TB risk in the presence of DM was OR = 2.3, 95% CI = [2.0–2.7], I2 = 94.2%. This statistically significant association was maintained in cohort (OR = 2.0, CI 95% = [1.5–2.4], I2 = 94.3%), case control (OR = 2.4, CI 95% = [2.0–2.9], I2 = 93.0%) and cross-sectional studies (OR = 2.5, CI 95% = [1.8–3.5], I2 = 95.2%). The association between DM and TB was also maintained in the sensitivity analysis including only studies with similar proportions of confounders between cases and controls. The substantial heterogeneity observed was mainly explained by the differences between geographic regions. Conclusions DM is associated with an increased risk of developing latent and active TB. To further explore the role of DM in the development of TB, more investigations of the biological mechanisms by which DM increases the risk of TB are needed. Review registration PROSPERO, CRD42021216815.
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Affiliation(s)
- Joseph Rodrigue Foe-Essomba
- Camdiagnostic, Ministry of Scientific Research and Innovation, Yaounde, Cameroon
- Faculty of Medicine and Biomedical Sciences, The University of Yaounde I, Yaounde, Cameroon
- Department of Mycobacteriology, Centre Pasteur of Cameroon, Yaounde, Cameroon
| | - Sebastien Kenmoe
- Virology Department, Centre Pasteur of Cameroon, Yaounde, Cameroon
| | | | - Jean Thierry Ebogo-Belobo
- Medical Research Centre, Institute of Medical Research and Medicinal Plants Studies, Yaounde, Cameroon
| | | | - Cyprien Kengne-Ndé
- Evaluation and Research Unit, National AIDS Control Committee, Yaounde, Cameroon
| | - Gadji Mahamat
- Department of Microbiology, The University of Yaounde I, Yaounde, Cameroon
| | - Ginette Irma Kame-Ngasse
- Medical Research Centre, Institute of Medical Research and Medicinal Plants Studies, Yaounde, Cameroon
| | - Efietngab Atembeh Noura
- Medical Research Centre, Institute of Medical Research and Medicinal Plants Studies, Yaounde, Cameroon
| | | | | | | | | | | | - Inès Nyebe
- Department of Microbiology, The University of Yaounde I, Yaounde, Cameroon
| | | | | | | | | | | | - Arnol Bowo-Ngandji
- Department of Microbiology, The University of Yaounde I, Yaounde, Cameroon
| | - Eric Lontchi-Yimagou
- Laboratory for Molecular Medicine and Metabolism, The University of Yaounde I, Yaounde, Cameroon
| | - Afi Leslie Kaiyven
- Institute of Biomedical and Clinical Research, University of Exeter, Exeter, United Kingdom
| | | | - Richard Njouom
- Virology Department, Centre Pasteur of Cameroon, Yaounde, Cameroon
| | - Jean Claude Mbanya
- Laboratory for Molecular Medicine and Metabolism, The University of Yaounde I, Yaounde, Cameroon
| | | | - Sara Eyangoh
- Department of Mycobacteriology, Centre Pasteur of Cameroon, Yaounde, Cameroon
- * E-mail:
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Cox SE, Edwards T, Faguer BN, Ferrer JP, Suzuki SJ, Koh M, Ferdous F, Saludar NR, Garfin AMCG, Castro MC, Solon JA. Patterns of non-communicable comorbidities at start of tuberculosis treatment in three regions of the Philippines: The St-ATT cohort. PLOS GLOBAL PUBLIC HEALTH 2021; 1:e0000011. [PMID: 36962076 PMCID: PMC10021424 DOI: 10.1371/journal.pgph.0000011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 10/20/2021] [Indexed: 11/18/2022]
Abstract
Diabetes and undernutrition are common risk factors for tuberculosis (TB), associated with poor treatment outcomes and exacerbated by TB. Limited data exist describing patterns and risk factors of multiple comorbidities in persons with TB. Nine-hundred participants (69.6% male) were enrolled in the Starting Anti-TB Treatment (St-ATT) cohort, including 133 (14.8%) initiating treatment for multi-drug resistant TB (MDR-TB). Comorbidities were defined as: diabetes, HbA1c ≥6.5% and/or on medication; hypertension, systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg and/or on medication; anaemia (moderate/severe), haemoglobin <11g/dL; and, undernutrition (moderate/severe) body-mass-index <17 kg/m2. The most common comorbidities were undernutrition 23.4% (210/899), diabetes 22.5% (199/881), hypertension 19.0% (164/864) and anaemia 13.5% (121/899). Fifty-eight percent had ≥1 comorbid condition (496/847), with 17.1% having ≥2; most frequently diabetes and hypertension (N = 57, 6.7%). Just over half of diabetes (54.8%) and hypertension (54.9%) was previously undiagnosed. Poor glycemic control in those on medication (HbA1c≥8.0%) was common (N = 50/73, 68.5%). MDR-TB treatment was associated with increased odds of diabetes (Adjusted odds ratio (AOR) = 2.48, 95% CI: 1.55-3.95); but decreased odds of hypertension (AOR = 0.55, 95% CI: 0.39-0.78). HIV infection was only associated with anaemia (AOR = 4.51, 95% CI: 1.01-20.1). Previous TB treatment was associated with moderate/severe undernutrition (AOR = 1.98, 95% CI: 1.40-2.80), as was duration of TB-symptoms before starting treatment and household food insecurity. No associations for sex, alcohol or tobacco use were observed. MDR-TB treatment was marginally associated with having ≥2 comorbidities (OR = 1.52, 95% CI: 0.97-2.39). TB treatment programmes should plan for large proportions of persons requiring diagnosis and management of comorbidities with the potential to adversely affect TB treatment outcomes and quality of life. Dietary advice and nutritional management are components of comprehensive care for the above conditions as well as TB and should be included in planning of patient-centred services.
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Affiliation(s)
- Sharon E Cox
- Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- School of Tropical Medicine & Global Health, Nagasaki University, Nagasaki, Japan
- Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Tansy Edwards
- School of Tropical Medicine & Global Health, Nagasaki University, Nagasaki, Japan
- International Statistics and Epidemiology Group, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Benjamin N Faguer
- School of Tropical Medicine & Global Health, Nagasaki University, Nagasaki, Japan
| | - Julius P Ferrer
- Nutrition Center Philippines, Muntinlupa City, Manila, Philippines
| | - Shuichi J Suzuki
- School of Tropical Medicine & Global Health, Nagasaki University, Nagasaki, Japan
| | - Mitsuki Koh
- School of Tropical Medicine & Global Health, Nagasaki University, Nagasaki, Japan
| | - Farzana Ferdous
- School of Tropical Medicine & Global Health, Nagasaki University, Nagasaki, Japan
| | | | | | - Mary C Castro
- Nutrition Center Philippines, Muntinlupa City, Manila, Philippines
| | - Juan A Solon
- Nutrition Center Philippines, Muntinlupa City, Manila, Philippines
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Zhang QY, Yang DM, Cao LQ, Liu JY, Tao NN, Li YF, Liu Y, Song WM, Xu TT, Li SJ, An QQ, Liu SQ, Gao L, Song WY, Li HC. Association between economic development level and tuberculosis registered incidence in Shandong, China. BMC Public Health 2020; 20:1557. [PMID: 33066742 PMCID: PMC7565316 DOI: 10.1186/s12889-020-09627-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 09/29/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) is one of the major infectious diseases that seriously endanger people's health. In Shandong province, the relationship between the level of economic development and TB incidence has not been studied. This study aims to provide more research basis for the government to prevent and control TB by exploring the impact of different economic factors on TB incidence. METHODS By constructing threshold regression model (TRM), we described the extent to which different economic factors contribute to TB registered incidence and differences in TB registered incidence among seventeen cities with different levels of economic development in Shandong province, China, during 2006-2017. Data were retrieved from the China Information System for Disease Control and Prevention. RESULTS Per capita medical expenditure (regression coefficient, -0.0314462; SD, 0.0079305; P > |t|, 0.000) and per capita savings (regression coefficient, 0.0001924; SD, 0.0000566; P > |t|, 0.001) passed the significance test at the level of 1%.They are the two economic indicators that have the greatest impact on TB registered incidence. Through the threshold test, we selected the per capita savings as the threshold variable. In the three stages of per capita savings (<9772.8086 China Yuan(CNY); 9772.8086-33,835.5391 CNY; >33,835.5391 CNY), rural per capita income always has a significant negative impact on the TB registered incidence (The regression coefficients are - 0.0015682, - 0.0028132 and - 0.0022253 respectively. P is 0.007,0.000 and 0.000 respectively.).In cities with good economies, TB registered incidence was 38.30% in 2006 and dropped to 25.10% by 2017. In cities with moderate economies, TB registered incidence peaked in 2008 at 43.10% and dropped to 27.1% by 2017.In poorer cities, TB registered incidence peaked in 2008 at 56.30% and dropped to 28.9% in 2017. CONCLUSION We found that per capita savings and per capita medical expenditure are most closely related to the TB incidence. Therefore, relevant departments should formulate a more complete medical system and medical insurance policy to effectively solve the problem of "difficult and expensive medical treatment". In order to further reduce the TB incidence, in addition to timely and accurate diagnosis and treatment, it is more important for governments to increase investment in medicine and health care.
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Affiliation(s)
- Qian-Yun Zhang
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Jingwuweiqi Road, Huaiyin District, Jinan, 250021, Shandong, China
- Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
| | - Dong-Mei Yang
- College of statistics, Shandong University of Finance and Economics, Jinan, 250202, Shandong, China
| | - Lin-Qing Cao
- College of statistics, Shandong University of Finance and Economics, Jinan, 250202, Shandong, China
| | - Jin-Yue Liu
- Department of Intensive Care Unit, Shandong Provincial Third Hospital, Jinan, 100191, Shandong, China
| | - Ning-Ning Tao
- Peking Union Medical College, Beijing, 100005, China
| | - Yi-Fan Li
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Jingwuweiqi Road, Huaiyin District, Jinan, 250021, Shandong, China
| | - Yao Liu
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Jingwuweiqi Road, Huaiyin District, Jinan, 250021, Shandong, China
| | - Wan-Mei Song
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Jingwuweiqi Road, Huaiyin District, Jinan, 250021, Shandong, China
- Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
| | - Ting-Ting Xu
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Jingwuweiqi Road, Huaiyin District, Jinan, 250021, Shandong, China
| | - Shi-Jin Li
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Jingwuweiqi Road, Huaiyin District, Jinan, 250021, Shandong, China
- Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
| | - Qi-Qi An
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Jingwuweiqi Road, Huaiyin District, Jinan, 250021, Shandong, China
- Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
| | - Si-Qi Liu
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Jingwuweiqi Road, Huaiyin District, Jinan, 250021, Shandong, China
- Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
| | - Lei Gao
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, 100730, Beijing, P. R. China
| | - Wan-Yan Song
- International College, Jiangxi University of Finance and Economics, Nanchang, Jiangxi, China
| | - Huai-Chen Li
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Jingwuweiqi Road, Huaiyin District, Jinan, 250021, Shandong, China.
- Shandong University of Traditional Chinese Medicine, Jinan, 250355, Shandong, China.
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Song WM, Shao Y, Liu JY, Tao NN, Liu Y, Zhang QY, Xu TT, Li SJ, Yu CB, Gao L, Cui LL, Li YF, Li HC. Primary drug resistance among tuberculosis patients with diabetes mellitus: a retrospective study among 7223 cases in China. Infect Drug Resist 2019; 12:2397-2407. [PMID: 31447568 PMCID: PMC6684854 DOI: 10.2147/idr.s217044] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 07/16/2019] [Indexed: 12/13/2022] Open
Abstract
Background Given the high burden of tuberculosis (TB) and diabetes mellitus (DM) in China and the worse outcome of TB-DM cases (refers to TB patients with diabetes), and drug-resistant tuberculosis cases (DR-TB), it is of great significance to explore the association between diabetes and primary DR-TB for TB elimination target in China. We assessed the clinical characteristics, drug-resistance profile, and increased risk of resistance among TB-DM patients across China from 2004 to 2017. Method 7223 cases with drug-susceptibility data were collected from Shandong, China. Categorical baseline characteristics of new TB cases were compared by DM status using Fisher's exact or Pearson Chi-square test. Univariable analysis and multivariable logistic models were used to estimate the association between diabetes and different drug-resistance profiles and the risk factors of primary drug resistance among TB-DM cases. Result Of 7223 newly diagnosed TB patients, 426 (5.90%) were TB-DM cases. TB-DM csaes were more likely to be older,accompanied by higher body mass index (BMI) and hypertension than TB-no DM cases (refers to TB patients without diabetes). The rates of DR-TB (21.83% vs 16.96%), polydrug resistant TB (PDR-TB, 6.10% vs 3.80%), isoniazid (INH)+streptomycin (SM)-resistant TB (4.93% vs 3.13%), and SM-resistant TB (16.20% vs 11.7%) among TB-DM group were higher than TB-no DM group, P<0.05. DM was significantly associated with any DR-TB (adjusted (aOR):1.30; 95% CI, 1.02-1.65), SM-related resistance (aOR: 1.43; 95% CI, 1.08-1.88), PDR-TB (OR: 1.57; 95% CI, 1.04-2.36; aOR: 1.59; 95% CI, 1.04-2.44), compared with pan-susceptible TB patients (P<0.05). Conclusion Our study indicated that TB-DM groups had a higher proportion of drug resistance than TB groups, and diabetes was identified as a risk factor of total DR, PDR, SM resistance and INH+SM resistance among newly diagnosed TB cases. Good management of diabetes and TB infection screening program among DM patients might be necessary for improving TB control in China.
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Affiliation(s)
- Wan-Mei Song
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong, People's Republic of China.,Department of Clinical Medicine, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong, People's Republic of China
| | - Yang Shao
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong, People's Republic of China
| | - Jin-Yue Liu
- Department of Clinical Medicine, School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan 250200, Shandong, People's Republic of China
| | - Ning-Ning Tao
- Department of Clinical Medicine, Medical College, Graduate School of Peking Union Medical College, Beijing 100005, People's Republic of China
| | - Yao Liu
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong, People's Republic of China
| | - Qian-Yun Zhang
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong, People's Republic of China.,Department of Clinical Medicine, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong, People's Republic of China
| | - Ting-Ting Xu
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong, People's Republic of China
| | - Shi-Jin Li
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong, People's Republic of China.,Department of Clinical Medicine, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong, People's Republic of China
| | - Chun-Bao Yu
- Department of Respiratory Medicine, Shandong Provincial Chest Hospital, Jinan 250013, Shandong, People's Republic of China
| | - Lei Gao
- National Health Commssion Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, People's Republic of China
| | - Liang-Liang Cui
- Department of Environmental Health, Jinan Municipal Center for Disease Control and Prevention, Jinan 250021, Shandong, People's Republic of China.,Department of Biostatistics, School of Public Health, Shandong University, Jinan 250012, Shandong, People's Republic of China
| | - Yi-Fan Li
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong, People's Republic of China
| | - Huai-Chen Li
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong, People's Republic of China.,Department of Chinese Medicine Integrated with Western Medicine, College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan 250355, Shandong, People's Republic of China
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