Diabetes mellitus and risk of all-cause mortality among patients with tuberculosis in the state of Georgia, 2009-2012

• Type of Material: Article
• Authors: Matthew James Magee, Emory University; M Foote, Emory University; DM Maggio, Georgia Department of Public Health; Penelope Howards, Emory University; K.M. Venkat Narayan, Emory University; Henry Michael Blumberg, Emory University; Susan M Ray, Emory University; Russell Ryan Kempker, Emory University
• Language: English
• Date: 2014-05-01
• Publisher: Elsevier: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2014 Elsevier Inc.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.annepidem.2014.01.012
• Title of Journal or Parent Work: Annals of Epidemiology
• ISSN: 1047-2797
• Volume: 24
• Issue: 5
• Start Page: 369
• End Page: 375
• Keywords: Mortality; TREATMENT OUTCOMES; DEATHS; HIV; CELLS; Public, Environmental & Occupational Health; IMPACT; Life Sciences & Biomedicine; US; Tuberculosis; PULMONARY TUBERCULOSIS; Diabetes mellitus; POPULATION; Science & Technology; Georgia
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Public Health; Health Sciences, Medicine and Surgery

Abstract

Purpose: To estimate the association between diabetes mellitus (DM) and all-cause mortality during tuberculosis (TB) treatment. Methods: From 2009 to 2012, a retrospective cohort study among reported TB cases in Georgia was conducted. Patients aged 16 years or older were classified by DM and human immunodeficiency virus (HIV) status at the time of TB diagnosis and followed during TB treatment to assess mortality. Hazard ratios were used to estimate the association between DM and death. Results: Among 1325 patients with TB disease, 151 (11.4%) had DM, 147 (11.1%) were HIV-infected, and seven (0.5%) had both DM and HIV. Patients with TB-DM were more likely to have cavitary lung disease compared with those with TB alone (51.0% vs. 34.7%) and those with TB-HIV were more likely to have military/disseminated disease (12.9% vs. 3.4%) and resistance to rifampin or isoniazid (21.8% vs. 9.0%) compared with those without HIV infection (P < .05). In multivariable analysis, DM was not associated with death during TB treatment (hazard ratio, 1.22; 95% confidence interval, 0.70-2.12) or any death (adjusted odds ratio, 1.05; 95% confidence interval, 0.60-1.84). Conclusions: Among TB patients in Georgia, the prevalence of comorbid DM and coinfection with HIV was nearly identical. In adjusted models, TB patients with DM did not have increased risk of all-cause mortality.