Diabetic trends and associated mortality in tuberculosis patients in Texas, a large population-based analysis

BACKGROUND: Tuberculosis (TB) and diabetes mellitus (DM) comorbidity (TB-DM) is a major public health challenge worldwide. This analysis aimed to determine the risk factors and trends associated with TB-DM morbidity and mortality.

METHODS: Risk factors for TB-DM morbidity and mortality were identified by logistic regression using de-identified surveillance data of all TB patients from Texas, USA. reported between 01/2010-12/2016. Non-parametric testing was used for the morbidity and mortality trends.

RESULTS: From 2010 to 2016, 1400/9002 (15.6%) TB patients were diabetic with an annual prevalence increase from 12.5% to 18.7% (p = 0.005). Reported TB-DM patients had a higher mortality (10.3%) than non-DM patients (7.6%, p = 0.001) with nearly a 3-fold increase in the odds of death (overall and during treatment). Older age, being Hispanic, chronic kidney failure, pulmonary cavitation and positive TB culture or smear were associated with TB-DM. Age ≥45, US-birth, resident of long-term care facility, injecting-drug user, chronic kidney disease, TB meningitis, abnormal chest radiograph, non-conversion of culture, and HIV(+) were independently associated with a higher mortality.

CONCLUSIONS: TB-DM is an increasing public health problem in Texas with significantly high mortality. Risk factors for mortality determined by multivariate modeling will provide a foundation for the development of more effective strategies for TB-DM management.