患有糖尿病的患者发生结核病的风险增加：巴塞罗那市区的一项队列研究（西班牙）。

Subjects With Diabetes Mellitus Are at Increased Risk for Developing Tuberculosis: A Cohort Study in an Inner-City District of Barcelona (Spain).

机构信息

DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.

Primary Health Care Center Bordeta Magòria, Gerència d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain.

出版信息

Front Public Health. 2022 May 23;10:789952. doi: 10.3389/fpubh.2022.789952. eCollection 2022.

DOI:10.3389/fpubh.2022.789952

PMID:35677764

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9168433/

Abstract

BACKGROUND

Tuberculosis is the leading cause of mortality from lung infectious disease worldwide in recent years, and its incidence has re-emerged in large cities in low-incidence countries due to migration and socioeconomic deprivation causes. Diabetes mellitus and tuberculosis are syndemic diseases, with diabetes being considered a risk factor for developing tuberculosis.

OBJECTIVE

To investigate whether diabetic patients were at increased risk of tuberculosis living in an inner-district of a large city of northeastern Spain.

METHODS

Observational matched retrospective cohort study based on clinical records from the population of the lowest socioeconomic status in Barcelona (Ciutat Vella district). A cohort including patients with type 1 and type 2 diabetes mellitus in 2007 and new cases until 2016 (8004 subjects), matched 1:1 by sex and age with a non-diabetic cohort. Follow-up period was until December 31st 2018. We evaluated the risk of developing tuberculosis in diabetic patients compared to non-diabetic patients during the follow up period. We used time-to-event analysis to estimate the incidence of tuberculosis, and competing risks regression by clusters and conditional Cox regression models to calculate the hazard ratio (HR) and its 95% confidence intervals (CI).

RESULTS

Among the 16,008 included subjects, the median follow-up was 8.7 years. The mean age was 57.7 years; 61.2% men and 38.8% women in both groups. The incidence of tuberculosis was 69.9 per 100,000 person-years in diabetic patients, and 40.9 per 100,000 person-years in non-diabetic patients (HR = 1.90; CI: 1.18-3.07). After adjustment for the country of origin, chronic kidney disease, number of medical appointments, BMI, alcoholism and smoking, the risk remained higher in diabetic patients (1.66: CI 0.99-2.77). Additionally, subjects from Hindustan or with a history of alcohol abuse also showed a higher risk of developing tuberculosis (HR = 3.51; CI:1.87-6.57, and HR = 2.73; CI:1.22-6.12 respectively).

CONCLUSION

People with diabetes mellitus were at higher risk of developing tuberculosis in a large cohort recruited in an inner-city district with a high incidence for this outcome, and low socioeconomic conditions and high proportion of migrants. This risk was higher among Hindustan born and alcohol abusers.

摘要

背景

近年来，结核病是导致全球肺部传染病死亡的主要原因，在低发病率国家的大城市，由于移民和社会经济贫困等原因，结核病的发病率再次出现。糖尿病和结核病是综合征疾病，糖尿病被认为是患结核病的危险因素。

目的

研究居住在西班牙东北部大城市中心区的糖尿病患者是否患结核病的风险增加。

方法

这是一项基于巴塞罗那（老城区）社会经济地位最低人群的临床记录的观察性匹配回顾性队列研究。2007 年纳入了 1 型和 2 型糖尿病患者队列，并在性别和年龄上与非糖尿病队列进行了 1:1 匹配，新病例持续到 2016 年（8004 例患者）。随访期截至 2018 年 12 月 31 日。我们评估了糖尿病患者与非糖尿病患者在随访期间发生结核病的风险。我们使用时间事件分析来估计结核病的发病率，并使用聚类和条件 Cox 回归模型计算竞争风险回归的风险比（HR）及其 95%置信区间（CI）。

结果

在纳入的 16008 例患者中，中位随访时间为 8.7 年。平均年龄为 57.7 岁；两组中，男性占 61.2%，女性占 38.8%。糖尿病患者的结核病发病率为 69.9/100000 人年，非糖尿病患者为 40.9/100000 人年（HR=1.90；95%CI：1.18-3.07）。在调整原籍国、慢性肾脏病、就诊次数、BMI、酗酒和吸烟后，糖尿病患者的风险仍然较高（1.66：95%CI 0.99-2.77）。此外，来自印度斯坦或有酗酒史的患者也有更高的患结核病风险（HR=3.51；95%CI：1.87-6.57，HR=2.73；95%CI：1.22-6.12）。