Risk of tuberculosis among people with diabetes mellitus: An Australian nationwide cohort study

Claudia Caroline Dobler, Jeffrey Ronald Flack, Guy Barrington Marks

Research output: Contribution to journalArticleResearchpeer-review

49 Citations (Scopus)

Abstract

Objective: Previous studies that have found an increased risk for tuberculosis (TB) in people with diabetes mellitus (DM) have been conducted in segments of the population and have not adjusted for important potential confounders. We sought to determine the RR for TB in the presence of DM in a national population with data on confounding factors in order to inform the decision-making process about latent tuberculosis infection (LTBI) screening in people with diabetes. Design: Whole population historical cohort study. Setting: All Australian States and Territories with a mean TB incidence of 5.8/100 000. Participants: Cases of TB in people with DM were identified by record linkage using the National Diabetes Services Scheme Database and TB notification databases for the years 2001-2006. Primary and secondary outcome measures: Primary outcome was notified cases of TB. Secondary outcome was notified cases of culture-confirmed TB. RR of TB was estimated with adjustment for age, sex, TB incidence in country of birth and indigenous status. Results: There were 6276 cases of active TB among 19 855 283 people living in Australia between 2001 and 2006. There were 271 (188 culture positive) cases of TB among 802 087 members of the DM cohort and 130 cases of TB among 273 023 people using insulin. The crude RR of TB was 1.78 (95% CI 1.17 to 2.73) in all people with DM and 2.16 (95% CI 1.19 to 3.93) in people with DM using insulin. The adjusted RRs were 1.48 (95% CI 1.04 to 2.10) and 2.27 (95% CI 1.41 to 3.66), respectively. Conclusions: The presence of DM alone does not justify screening for LTBI. However, when combined with other risk factors for TB, the presence of DM may be sufficient to justify screening and treatment for LTBI.

Original languageEnglish
Article number000666
JournalBMJ Open
Volume2
Issue number1
DOIs
Publication statusPublished - 12 Mar 2012
Externally publishedYes

Fingerprint

Diabetes Mellitus
Tuberculosis
Cohort Studies
Latent Tuberculosis
Databases
Insulin
Population
Incidence
Decision Making
Outcome Assessment (Health Care)
Parturition

Cite this

@article{fb066696aff140cbba4e978c9a5fd7b2,
title = "Risk of tuberculosis among people with diabetes mellitus: An Australian nationwide cohort study",
abstract = "Objective: Previous studies that have found an increased risk for tuberculosis (TB) in people with diabetes mellitus (DM) have been conducted in segments of the population and have not adjusted for important potential confounders. We sought to determine the RR for TB in the presence of DM in a national population with data on confounding factors in order to inform the decision-making process about latent tuberculosis infection (LTBI) screening in people with diabetes. Design: Whole population historical cohort study. Setting: All Australian States and Territories with a mean TB incidence of 5.8/100 000. Participants: Cases of TB in people with DM were identified by record linkage using the National Diabetes Services Scheme Database and TB notification databases for the years 2001-2006. Primary and secondary outcome measures: Primary outcome was notified cases of TB. Secondary outcome was notified cases of culture-confirmed TB. RR of TB was estimated with adjustment for age, sex, TB incidence in country of birth and indigenous status. Results: There were 6276 cases of active TB among 19 855 283 people living in Australia between 2001 and 2006. There were 271 (188 culture positive) cases of TB among 802 087 members of the DM cohort and 130 cases of TB among 273 023 people using insulin. The crude RR of TB was 1.78 (95{\%} CI 1.17 to 2.73) in all people with DM and 2.16 (95{\%} CI 1.19 to 3.93) in people with DM using insulin. The adjusted RRs were 1.48 (95{\%} CI 1.04 to 2.10) and 2.27 (95{\%} CI 1.41 to 3.66), respectively. Conclusions: The presence of DM alone does not justify screening for LTBI. However, when combined with other risk factors for TB, the presence of DM may be sufficient to justify screening and treatment for LTBI.",
author = "Dobler, {Claudia Caroline} and Flack, {Jeffrey Ronald} and Marks, {Guy Barrington}",
year = "2012",
month = "3",
day = "12",
doi = "10.1136/bmjopen-2011-000666",
language = "English",
volume = "2",
journal = "BMJ Open",
issn = "2044-6055",
publisher = "BMJ Publishing Group",
number = "1",

}

Risk of tuberculosis among people with diabetes mellitus : An Australian nationwide cohort study. / Dobler, Claudia Caroline; Flack, Jeffrey Ronald; Marks, Guy Barrington.

In: BMJ Open, Vol. 2, No. 1, 000666, 12.03.2012.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Risk of tuberculosis among people with diabetes mellitus

T2 - An Australian nationwide cohort study

AU - Dobler, Claudia Caroline

AU - Flack, Jeffrey Ronald

AU - Marks, Guy Barrington

PY - 2012/3/12

Y1 - 2012/3/12

N2 - Objective: Previous studies that have found an increased risk for tuberculosis (TB) in people with diabetes mellitus (DM) have been conducted in segments of the population and have not adjusted for important potential confounders. We sought to determine the RR for TB in the presence of DM in a national population with data on confounding factors in order to inform the decision-making process about latent tuberculosis infection (LTBI) screening in people with diabetes. Design: Whole population historical cohort study. Setting: All Australian States and Territories with a mean TB incidence of 5.8/100 000. Participants: Cases of TB in people with DM were identified by record linkage using the National Diabetes Services Scheme Database and TB notification databases for the years 2001-2006. Primary and secondary outcome measures: Primary outcome was notified cases of TB. Secondary outcome was notified cases of culture-confirmed TB. RR of TB was estimated with adjustment for age, sex, TB incidence in country of birth and indigenous status. Results: There were 6276 cases of active TB among 19 855 283 people living in Australia between 2001 and 2006. There were 271 (188 culture positive) cases of TB among 802 087 members of the DM cohort and 130 cases of TB among 273 023 people using insulin. The crude RR of TB was 1.78 (95% CI 1.17 to 2.73) in all people with DM and 2.16 (95% CI 1.19 to 3.93) in people with DM using insulin. The adjusted RRs were 1.48 (95% CI 1.04 to 2.10) and 2.27 (95% CI 1.41 to 3.66), respectively. Conclusions: The presence of DM alone does not justify screening for LTBI. However, when combined with other risk factors for TB, the presence of DM may be sufficient to justify screening and treatment for LTBI.

AB - Objective: Previous studies that have found an increased risk for tuberculosis (TB) in people with diabetes mellitus (DM) have been conducted in segments of the population and have not adjusted for important potential confounders. We sought to determine the RR for TB in the presence of DM in a national population with data on confounding factors in order to inform the decision-making process about latent tuberculosis infection (LTBI) screening in people with diabetes. Design: Whole population historical cohort study. Setting: All Australian States and Territories with a mean TB incidence of 5.8/100 000. Participants: Cases of TB in people with DM were identified by record linkage using the National Diabetes Services Scheme Database and TB notification databases for the years 2001-2006. Primary and secondary outcome measures: Primary outcome was notified cases of TB. Secondary outcome was notified cases of culture-confirmed TB. RR of TB was estimated with adjustment for age, sex, TB incidence in country of birth and indigenous status. Results: There were 6276 cases of active TB among 19 855 283 people living in Australia between 2001 and 2006. There were 271 (188 culture positive) cases of TB among 802 087 members of the DM cohort and 130 cases of TB among 273 023 people using insulin. The crude RR of TB was 1.78 (95% CI 1.17 to 2.73) in all people with DM and 2.16 (95% CI 1.19 to 3.93) in people with DM using insulin. The adjusted RRs were 1.48 (95% CI 1.04 to 2.10) and 2.27 (95% CI 1.41 to 3.66), respectively. Conclusions: The presence of DM alone does not justify screening for LTBI. However, when combined with other risk factors for TB, the presence of DM may be sufficient to justify screening and treatment for LTBI.

UR - http://www.scopus.com/inward/record.url?scp=84857869767&partnerID=8YFLogxK

U2 - 10.1136/bmjopen-2011-000666

DO - 10.1136/bmjopen-2011-000666

M3 - Article

VL - 2

JO - BMJ Open

JF - BMJ Open

SN - 2044-6055

IS - 1

M1 - 000666

ER -