Tuberculosis Infection Among People With Diabetes: United States Population Differences by Race/Ethnicity

• Type of Material: Article
• Authors: Maryam Haddad, Emory University; Timothy Lash, Emory University; Kenneth Castro, Emory University; Andrew Hill, Emory University; Thomas R Navin, Centers for Disease Control and Prevention, Atlanta; Neel Gandhi, Emory University; Matthew Magee, Emory University
• Language: English
• Date: 2020-06-01
• Publisher: ELSEVIER SCIENCE INC
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.amepre.2019.12.010
• Title of Journal or Parent Work: AMERICAN JOURNAL OF PREVENTIVE MEDICINE
• Volume: 58
• Issue: 6
• Start Page: 858
• End Page: 863
• Grant/Funding Information: This is publicly funded research; the NHANES 2011–2012 public-use data sets are available from wwwn.cdc.gov/nchs/nhanes/. MBH and several coauthors are or were employees of the Centers for Disease Control and Prevention.; This work was also supported by the NIH (National Institute of Allergy and Infectious Disease K24 grant, 1K24AI114444 to NRG and R03AI133173 to MJM) and an existing U.S. Agency for International Development Intergovernmental Personnel Act agreement with Emory University (KGC).
• Keywords: Science & Technology; Life Sciences & Biomedicine; RIFAPENTINE; PREVALENCE; Public, Environmental & Occupational Health; Medicine, General & Internal; General & Internal Medicine

Abstract

Introduction: Diabetes might confer a modestly increased risk of latent tuberculosis infection, which without treatment can progress to active tuberculosis disease. Three recent analyses of the National Health and Nutrition Examination Survey found a positive association between diabetes and a positive test for Mycobacterium tuberculosis infection. This study examines whether prevalence of a positive test still varies by diabetes status after stratifying by race/ethnicity. Methods: This cross-sectional analysis used the public-use National Health and Nutrition Examination Survey 2011–2012 data sets and was conducted in 2018–2019. Interview and examination results for 5,560 adult participants yielded estimates for 219 million U.S. adults in the 4 largest race/ethnicity groups. The weighted prevalence of positive tuberculin skin test or interferon-gamma release assay by diabetes status was ascertained in each group. Results: Among white and black adults, diabetes was associated with no difference in positive skin test prevalence and little difference in positive interferon-gamma release assay prevalence. The positive assay prevalence difference was +14.5% (95% CI=2.3%, 26.7%) among Hispanic and +9.9% (95% CI=1.2%, 18.6%) among Asian adults, when comparing those with diabetes with those with neither diabetes nor prediabetes. Based on assay results, 23.6% (95% CI=14.0%, 36.9%) of Hispanic and 27.2% (95% CI=19.6%, 36.5%) of Asian adults with diabetes also had latent tuberculosis infection. Conclusions: Hispanic and Asian subpopulation results drove much of the previously reported positive association between diabetes and a positive test for M. tuberculosis infection. Hispanic and Asian adults with diabetes might particularly benefit from screening and treatment for latent tuberculosis infection.