Tuberculosis and diabetes in southern Mexico.
OBJECTIVE
To determine the impact of diabetes on the rates of tuberculosis in a region where both diseases are prevalent.


METHODS
Data from a population-based cohort of patients with pulmonary tuberculosis undergoing clinical and mycobacteriologic evaluation (isolation, identification, drug-susceptibility testing, and IS6110-based genotyping and spoligotyping) were linked to the 2000 National Health Survey (ENSA2000), a national probabilistic, polystage, stratified, cluster household survey of the civilian, noninstitutionalized population of Mexico.


RESULTS
From March 1995 to March 2003, 581 patients with Mycobacterium tuberculosis culture and fingerprint were diagnosed, 29.6% of whom had been diagnosed previously with diabetes by a physician. According to the ENSA2000, the estimated prevalence of diabetes in the study area was 5.3% (95% CI 4.1-6.5). The estimated rates of tuberculosis for the study area were greater for patients with diabetes than for nondiabetic individuals (209.5 vs. 30.7 per 100000 person-years, P < 0.0001).


CONCLUSIONS
In this setting, the rate of tuberculosis was increased 6.8-fold (95% CI 5.7-8.2, P < 0.0001) in patients with diabetes due to increases in both reactivated and recently transmitted infection. Comorbidity with diabetes may increase tuberculosis rates as much as coinfection with human immunodeficiency virus (HIV), with important implications for the allocation of health care resources.
Ponce-De-Leon
Alfredo
A
National Institute of Medical Sciences and Nutrition, Salvador Zubirán, Distrito Federal, Mexico.
Garcia-Garcia Md
Ma de Lourdes
Mde L
Garcia-Sancho
Ma Cecilia
MC
Gomez-Perez
Francisco J
FJ
Valdespino-Gomez
Jose Luis
JL
Olaiz-Fernandez
Gustavo
G
Rojas
Rosalba
R
Ferreyra-Reyes
Leticia
L
Cano-Arellano
Bulmaro
B
Bobadilla
Miriam
M
Small
Peter M
PM
Sifuentes-Osornio
Jose
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000032:analysis; D016000:Cluster Analysis; D015331:Cohort Studies; D015897:Comorbidity; D003731:Dental Caries / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000453:epidemiology; D006801:Humans; D008297:Male; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D011336:Probability; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology*
D001786:Blood Glucose