Association Between Tuberculosis and Diabetes in the Mexican Border and Non-Border Regions of Texas

Abstract

The association between tuberculosis and underlying risk factors was evaluated in Texas patients hospitalized in the 15 counties along the Mexico border within the remaining non-border counties. A case control analysis of the hospital discharge dataset from the Texas Health Care Information Council was performed for the years 1999-2001. A discharge diagnosis of tuberculosis identified cases (N = 4,915). Deep venous thrombosis, pulmonary embolism, and acute appendicitis conditions identified controls (N = 70,808). Risk factors associated with tuberculosis were identified by logistic regression. Diabetes patients were almost twice as likely to have tuberculosis after adjusting by sex, age, and race/ethnicity. The association was strong for the population in the Texas border region, where there are higher incidence rates of tuberculosis (odds ratio [OR](adj) = 1.82; 95% CI = 1.57-2.12) compared with non-border counties (OR(adj) = 1.51; 95% CI = 1.36-1.67).

Cross-sectional assessment reveals high diabetes prevalence among newly-diagnosed tuberculosis cases

“…[6][7][8][9][10][11][12][13][14][15][16][17] One quarter of the cases of TB in these medically-underserved communities along the Texas-Mexico border were attributable to diabetes. With diabetes on the rise in TB-endemic areas, our findings highlight the re-emerging impact of diabetes, now type 2, on TB control in regions of the world where both diseases are prevalent.…”

“…4,5 This association (now with type 2 diabetes) was recognized again in the 1990s [6][7][8][9] and is currently supported by a growing body of literature. [6][7][8][9][10][11][12][13][14][15][16][17] According to a recent meta-analysis, diabetes patients have three times the risk of contracting TB as non-diabetics (95% confidence interval, CI: 2.3-4.3) 18 and studies report the fraction of TB cases attributable to diabetes to be between 15% and 25%. 9,13,16 The biological basis for the association between both diseases is not fully understood but studies suggest that diabetes depresses the immune response, which in turn facilitates infection with Mycobacterium tuberculosis and/or progression to symptomatic disease.…”

“…4,[19][20][21][22] Despite the suggested importance of diabetes as a risk factor for TB, most contemporary studies are based on secondary data or self-reported diabetes status. [6][7][8][9][10][11][12][13][14][15][16][17] The contribution of diabetes to the burden of TB may be more conspicuous in countries where both diseases are highly prevalent: Bangladesh, Brazil, China, India, Indonesia, Pakistan, and the Russian Federation are high-burden countries and rank among the 10 countries with the highest numbers of diabetes patients 2, 23 and also classified as high-burden for TB. However, the risk of TB attributable to diabetes has only been reported for India and it was estimated from secondary data.…”

Diabetes and Tuberculosis: The Study of Clinical-radiological Profile in Tertiary Care Hospital

“…DM is a well known risk factor for TB in the past 1,2. Patient with diabetes mellitus type-2 are in particular more prone to getting into infections, including TB, which are more difficult to treat because of their inherent weak immune system, the high prevalence of diabetes could adversely affect global TB control efforts 3,4 . 5 .…”

Excess Risk of Dying From Infectious Causes in Those With Type 1 and Type 2 Diabetes

“…Diabetes has also been associated with tuberculosis in several studies (5)(6)(7)(8) and has been shown to be a risk factor for severe gram-positive infections (9,10), hospital-acquired postoperative infections (11,12), and urinary tract infections (3).…”