Role of risk factors and socio‐economic status in pulmonary tuberculosis: a search for the root cause in patients in a tertiary care hospital, South India

Abstract

Summaryobjective To determine the frequency of underlying risk factors and the socio-economic impact based on occupation in the development of tuberculosis. results Diabetes mellitus (DM) (30.9%) was the most prevalent condition and significantly more common than other risk factors like smoking (16.9%), alcoholism (12.6%), HIV (10.6%), malignancy (5.8%), chronic liver diseases (3.9%), history of contact with TB (3.4%), chronic corticosteroid therapy (2.9%), chronic kidney diseases and malnourishment (1.5%). There were 82 patients (39.6%) with no underlying risk factor. Men (M:F = 3.7:1) and patients older than 40 years had a higher incidence of co-existing conditions. PTB was significantly more common in blue-collar (44%) and white-collar (27.1%) workers than household workers (12.1%), students (10.6%) and retired ⁄ unemployed people (6.3%).conclusion Pulmonary tuberculosis had a significant impact and predominated in male patients coexisting with DM. Patients with DM and suggestive pulmonary symptoms should be screened for tuberculosis. More stringent health education and awareness programme should be implemented at the grass root level. Although more focus is being given on TB-HIV coinfection as a major concern for public health, there are other underlying risk factors which compromise the immune status. Diabetes mellitus (DM) widely impairs neutrophil and macrophage functions (Ljubic et al. 2004) and thus can be a major aggravating risk factor for TB.

Assessment of Risk Factors among Pulmonary Tuberculosis Patients

“…In our study, 7.6% patients were HIV infected similar to this, Hill et al 13 and Gupta S et al 12 showed HIV prevalence of 6.1% and 10.6% in TB patients respectively in their studies. In our study, 10.2% patients had diabetes mellitus whereas study by Srivatava AB et al 14 …”

Socio-economic profile and risk factors among pulmonary tuberculosis patients in Madurai, India: a cross sectional study

“…15,16 In the present study, labourers were 37% and unemployed individuals (retired persons, students and housewives) were 33.4% in urban area but labourers were 49% and unemployed individuals (retired persons, students and housewives) were 19.4% in the rural area. This was very similar to the findings of Gupta et al, Khan, Muniyandi et al, Rajeswari et al and Gajbhare et al 4,5,15,25,27 A study by Schoeman et al argued that the role of socioeconomic status as a risk factor for TB was shown to be unclear but the study by Muniyandi et al reported that 61.75% cases belonged to Below Poverty Line (BPL). 25,28 In the present study, majority of the study participants were from middle and upper middle class in urban area and lower, middle, and upper middle class in rural area.…”

“…The middle age group had accounted for more than 60% of PTB both in urban and rural areas which were similar to the previous studies. 4,[17][18][19] It is noteworthy in the present study that 24.4% in urban area and 20.8% in rural area affected by PTB belonged to the age group of above 55 years. Since, in older age groups PTB might be present only as cough that could be ignored.…”

“…3,4 There are several studies to indicate a higher TB occurrence in patients with smoking, alcoholism, HIV/AIDS, malnutrition and Diabetes Mellitus (DM). [4][5][6][7] Morbidity and mortality due to TB has been brought down significantly through the application of WHO recommended DOTS strategy that was part of the Revised National Tuberculosis Control Programme (RNTCP). The aforesaid socio-economic characteristics were established to have a crucial role in the treatment success of TB patients under DOTS.…”

‘Diabetes and Tuberculosis’ – A Co-Epidemic of Public Health Importance in the Developing World

“…Balakrishnan et al 10 using glycosylated haemoglobin (HbA1c) as a diagnostic tool, reported DM prevalence of 44% among TB patients 10 . DM was found as the most frequent risk factor for pulmonary TB in another retrospective study from India 11 . Pakistan reported ten times higher prevalence of DM in TB patients compared to normal population 12 .…”