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Impact of diabetes and smoking on mortality in tuberculosis.

Reed GW, Choi H, Lee SY, Lee M, Kim Y, Park H, Lee J, Zhan X, Kang H, Hwang S, Carroll M, Cai Y, Cho SN, Barry CE, Via LE, Kornfeld H - PLoS ONE (2013)

Bottom Line: Results were compared in TB patients with and without diabetes or smoking history.Diabetes was present in 25% and was associated with greater radiographic severity and with recurrent or relapsed TB.In this cohort, the impact of diabetes on mortality was greater in patients younger than 50 years, compared to older patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America.

ABSTRACT

Background: Diabetes mellitus is a risk factor for tuberculosis (TB) disease. There is evidence that diabetes also influences TB severity and treatment outcomes but information is incomplete and some published results have been inconsistent.

Methods: A longitudinal cohort study was conducted at the National Masan Tuberculosis Hospital in the Republic of Korea. Subjects presenting with a first episode of TB or for retreatment of TB were followed from enrollment through completion of treatment. Demographic, clinical, and microbiological variables were recorded, along with assessment of outcomes. Results were compared in TB patients with and without diabetes or smoking history. Data were adjusted for gender, age, cohort, educational level and alcohol consumption.

Results: The combined cohorts comprised 657 subjects. Diabetes was present in 25% and was associated with greater radiographic severity and with recurrent or relapsed TB. Diabetes and cigarette smoking independently increased the risk of death in the first 12 months after enrollment. Estimating the combined impact of diabetes and smoking yielded a hazard ratio of 5.78. Only 20% of diabetic subjects were non-smokers; 54% smoked ≥1 pack daily. In this cohort, the impact of diabetes on mortality was greater in patients younger than 50 years, compared to older patients.

Conclusions: In this cohort of Korean patients, diabetes exacerbated the severity of TB disease. Diabetic subjects who smoked ≥1 pack of cigarettes daily were at particularly high risk of death from TB. Strategies to improve TB outcomes could productively focus resources for patient education and TB prevention on the vulnerable population of younger diabetics, particularly those who also smoke.

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Related in: MedlinePlus

Non-linear association of diabetes and age.Lowess smoothing curve [10] fit to diabetes prevalence vs. age. A spline fit model (knot at age = 50) is significantly different from a linear fit (p<0.001).
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pone-0058044-g001: Non-linear association of diabetes and age.Lowess smoothing curve [10] fit to diabetes prevalence vs. age. A spline fit model (knot at age = 50) is significantly different from a linear fit (p<0.001).

Mentions: Rates of diabetes were compared between cohort A (23.3%) and cohort B (25.2%), overall and within age groups <50 and ≥50 years (Table 2). While the multivariable adjusted OR was 1.15 (p = 0.517), the matched patient population showed an estimated increased risk for diabetes in cohort B, OR = 1.47 (p = 0.089). We noted that the association of diabetes and age was not linear (Fig. 1) so the risk of diabetes by cohort was examined within age groups (age <50 and age ≥50). Both matched and unmatched analyses indicated that the risk of diabetes in cohort B vs. cohort A differed by age group. There was no significant difference in the risk between these two cohorts for age <50, but there was an increased risk for diabetes in cohort B vs. cohort A for age ≥50 (OR = 3.05 unmatched, 2.22 matched). The multivariable model of diabetes risk included an interaction term of cohort and age group, testing the premise that ORage<50 = ORage≥50 and estimated a significant difference between the odds ratios (p = 0.002), where ORage<50 represents the risk of diabetes in cohort B vs. A within age group<50. This result was consistent with prior studies that demonstrated an increased risk for recurrent TB in diabetic vs. non-diabetic TB patients although in our population this was restricted to the older age group [6].


Impact of diabetes and smoking on mortality in tuberculosis.

Reed GW, Choi H, Lee SY, Lee M, Kim Y, Park H, Lee J, Zhan X, Kang H, Hwang S, Carroll M, Cai Y, Cho SN, Barry CE, Via LE, Kornfeld H - PLoS ONE (2013)

Non-linear association of diabetes and age.Lowess smoothing curve [10] fit to diabetes prevalence vs. age. A spline fit model (knot at age = 50) is significantly different from a linear fit (p<0.001).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3585219&req=5

pone-0058044-g001: Non-linear association of diabetes and age.Lowess smoothing curve [10] fit to diabetes prevalence vs. age. A spline fit model (knot at age = 50) is significantly different from a linear fit (p<0.001).
Mentions: Rates of diabetes were compared between cohort A (23.3%) and cohort B (25.2%), overall and within age groups <50 and ≥50 years (Table 2). While the multivariable adjusted OR was 1.15 (p = 0.517), the matched patient population showed an estimated increased risk for diabetes in cohort B, OR = 1.47 (p = 0.089). We noted that the association of diabetes and age was not linear (Fig. 1) so the risk of diabetes by cohort was examined within age groups (age <50 and age ≥50). Both matched and unmatched analyses indicated that the risk of diabetes in cohort B vs. cohort A differed by age group. There was no significant difference in the risk between these two cohorts for age <50, but there was an increased risk for diabetes in cohort B vs. cohort A for age ≥50 (OR = 3.05 unmatched, 2.22 matched). The multivariable model of diabetes risk included an interaction term of cohort and age group, testing the premise that ORage<50 = ORage≥50 and estimated a significant difference between the odds ratios (p = 0.002), where ORage<50 represents the risk of diabetes in cohort B vs. A within age group<50. This result was consistent with prior studies that demonstrated an increased risk for recurrent TB in diabetic vs. non-diabetic TB patients although in our population this was restricted to the older age group [6].

Bottom Line: Results were compared in TB patients with and without diabetes or smoking history.Diabetes was present in 25% and was associated with greater radiographic severity and with recurrent or relapsed TB.In this cohort, the impact of diabetes on mortality was greater in patients younger than 50 years, compared to older patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America.

ABSTRACT

Background: Diabetes mellitus is a risk factor for tuberculosis (TB) disease. There is evidence that diabetes also influences TB severity and treatment outcomes but information is incomplete and some published results have been inconsistent.

Methods: A longitudinal cohort study was conducted at the National Masan Tuberculosis Hospital in the Republic of Korea. Subjects presenting with a first episode of TB or for retreatment of TB were followed from enrollment through completion of treatment. Demographic, clinical, and microbiological variables were recorded, along with assessment of outcomes. Results were compared in TB patients with and without diabetes or smoking history. Data were adjusted for gender, age, cohort, educational level and alcohol consumption.

Results: The combined cohorts comprised 657 subjects. Diabetes was present in 25% and was associated with greater radiographic severity and with recurrent or relapsed TB. Diabetes and cigarette smoking independently increased the risk of death in the first 12 months after enrollment. Estimating the combined impact of diabetes and smoking yielded a hazard ratio of 5.78. Only 20% of diabetic subjects were non-smokers; 54% smoked ≥1 pack daily. In this cohort, the impact of diabetes on mortality was greater in patients younger than 50 years, compared to older patients.

Conclusions: In this cohort of Korean patients, diabetes exacerbated the severity of TB disease. Diabetic subjects who smoked ≥1 pack of cigarettes daily were at particularly high risk of death from TB. Strategies to improve TB outcomes could productively focus resources for patient education and TB prevention on the vulnerable population of younger diabetics, particularly those who also smoke.

Show MeSH
Related in: MedlinePlus