Article Text
Abstract
Introduction To describe diabetes trends among adults with incident tuberculosis (TB) disease and examine diabetes-associated TB characteristics and patient outcomes in the USA.
Research design and methods We examined all 71 855 persons aged ≥20 years with incident TB disease reported to the National Tuberculosis Surveillance System during 2010–2017. We performed multivariable logistic regression, comparing characteristics and outcomes among patients with TB reported to have diabetes and those whose diabetes status was unknown.
Results An overall 18% (n=13 281) of the 71 855 adults with incident TB disease were reported as also having diabetes; the annual proportion increased from 15% in 2010 to 22% in 2017. Among patients aged ≥45 years with both TB and diabetes, the adjusted OR for cavitary or sputum smear-positive TB was 1.7 and 1.5, respectively (95% CIs 1.5 to 1.8 and 1.4 to 1.6). Patients with TB and diabetes had 30% greater odds of dying and took longer to achieve negative Mycobacterium tuberculosis cultures and complete treatment.
Conclusions The prevalence of reported diabetes among adults with TB disease has increased. Having diabetes as a comorbidity negatively affects patient outcomes. In accordance with national recommendations, all patients aged ≥45 years and all younger patients who have risk factors for diabetes should be screened for diabetes at the start of TB treatment.
- tuberculosis
- epidemiology
- disease association
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Footnotes
Contributors LRA conceived and executed the analysis. JSK provided analytic assistance. JSK and MBH reviewed interim results, provided interpretation, and suggested additional analyses. LRA created the first draft of the article, and MBH revised the article. All authors approved the final version.
Funding This is a publicly funded research by employees of the Centers for Disease Control and Prevention, Atlanta, Georgia.
Disclaimer The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement The National Tuberculosis Surveillance System operates under an Assurance of Confidentiality issued by the Centers for Disease Control and Prevention (CDC) under Sections 306 and 308(d) of the Public Health Service Act (42 USC 242k and 242m(d)). Data are reported voluntarily to CDC by state and local health departments on a case report form called the Report of Verified Case of Tuberculosis (OMB No. 0920-0026). The Assurance of Confidentiality prevents disclosure of any information that could be used to directly or indirectly identify patients. For more information, see the CDC/ATSDR Policy on Releasing and Sharing Data (at http://www.cdc.gov/maso/Policy/ReleasingData.pdf). A limited dataset is available at http://wonder.cdc.gov/TB-v2013.html. Researchers may apply to analyze additional data at CDC headquarters by contacting TBInfo{at}cdc.gov.