Department of Medicine, Stanford Health Policy, CHP/PCOR, Stanford University School of Medicine, Stanford, CA, USA.
Int J Epidemiol. 2011 Apr;40(2):417-28. doi: 10.1093/ije/dyq238. Epub 2011 Jan 20.
A growing body of evidence supports the role of type 2 diabetes as an individual-level risk factor for tuberculosis (TB), though evidence from developing countries with the highest TB burdens is lacking. In developing countries, TB is most common among the poor, in whom diabetes may be less common. We assessed the relationship between individual-level risk, social determinants and population health in these settings.
We performed individual-level analyses using the World Health Survey (n = 124,607; 46 countries). We estimated the relationship between TB and diabetes, adjusting for gender, age, body mass index, education, housing quality, crowding and health insurance. We also performed a longitudinal country-level analysis using data on per-capita gross domestic product and TB prevalence and incidence and diabetes prevalence for 1990-95 and 2003-04 (163 countries) to estimate the relationship between increasing diabetes prevalence and TB, identifying countries at risk for disease interactions.
In lower income countries, individuals with diabetes are more likely than non-diabetics to have TB [univariable odds ratio (OR): 2.39; 95% confidence interval (CI): 1.84-3.10; multivariable OR: 1.81; 95% CI: 1.37-2.39]. Increases in TB prevalence and incidence over time were more likely to occur when diabetes prevalence also increased (OR: 4.7; 95% CI: 1.0-22.5; OR: 8.6; 95% CI: 1.9-40.4). Large populations, prevalent TB and projected increases in diabetes make countries like India, Peru and the Russia Federation areas of particular concern.
Given the association between diabetes and TB and projected increases in diabetes worldwide, multi-disease health policies should be considered.
越来越多的证据表明 2 型糖尿病是结核病（TB）的个体风险因素，尽管来自负担最重的发展中国家的证据尚缺乏。在发展中国家，TB 在贫困人口中最为常见，而在这些人中糖尿病可能不太常见。我们评估了这些环境中个体风险、社会决定因素和人群健康之间的关系。
我们使用世界卫生调查（n=124607；46 个国家）进行了个体水平的分析。我们调整了性别、年龄、体重指数、教育、住房质量、拥挤程度和医疗保险等因素，估计了 TB 和糖尿病之间的关系。我们还使用了 1990-95 年和 2003-04 年人均国内生产总值以及 TB 患病率和发病率以及糖尿病患病率的数据，对 163 个国家进行了纵向的国家水平分析，以估计糖尿病患病率的增加与 TB 之间的关系，确定疾病相互作用的风险国家。
在低收入国家，患有糖尿病的个体比非糖尿病个体更有可能患有 TB [单变量优势比（OR）：2.39；95%置信区间（CI）：1.84-3.10；多变量 OR：1.81；95% CI：1.37-2.39]。随着时间的推移，TB 患病率和发病率的增加更有可能发生在糖尿病患病率增加的情况下（OR：4.7；95% CI：1.0-22.5；OR：8.6；95% CI：1.9-40.4）。人口众多、TB 流行和预计糖尿病发病率的增加使印度、秘鲁和俄罗斯联邦等国家成为特别关注的地区。
鉴于糖尿病与 TB 之间的关联以及全球范围内糖尿病预计会增加，应考虑制定多疾病健康政策。
