title: Associations between selected immune-mediated diseases and tuberculosis: record-linkage studies.
abstract: BACKGROUND
  Previous studies have suggested that there may be an association between some immune-mediated diseases and risk of tuberculosis (TB).
  
  
  METHODS
  We analyzed a database of linked statistical records of hospital admissions and death certificates for the whole of England (1999 to 2011), and a similar database (the Oxford Record Linkage Study (ORLS)) for a region of southern England in an earlier period. Rate ratios for TB were determined, comparing immune-mediated disease cohorts with comparison cohorts.
  
  
  RESULTS
  In the all-England dataset, there were significantly elevated risks of TB after hospital admission for the following individual immune-mediated diseases: Addison's disease, ankylosing spondylitis, autoimmune hemolytic anemia, chronic active hepatitis, coeliac disease, Crohn's disease, dermatomyositis, Goodpasture's syndrome, Hashimoto's thyroiditis, idiopathic thrombocytopenia purpura (ITP), myasthenia gravis, myxedema, pemphigoid, pernicious anemia, polyarteritis nodosa, polymyositis, primary biliary cirrhosis, psoriasis, rheumatoid arthritis, scleroderma, Sjögren's syndrome, systemic lupus erythematosus (SLE), thyrotoxicosis and ulcerative colitis. Particularly high levels of risk were found for Addison's disease (rate ratio (RR) = 11.9 (95% CI 9.5 to 14.7)), Goodpasture's syndrome (RR = 10.8 (95% CI 4.0 to 23.5)), SLE (RR = 9.4 (95% CI 7.9 to 11.1)), polymyositis (RR = 8.0 (95% CI 4.9 to 12.2)), polyarteritis nodosa (RR = 6.7 (95% CI 3.2 to 12.4)), dermatomyositis (RR = 6.6 (95% CI 3.0 to 12.5)), scleroderma (RR = 6.1 (95% CI 4.4 to 8.2)) and autoimmune hemolytic anemia (RR = 5.1 (95% CI 3.4 to 7.4)).
  
  
  CONCLUSIONS
  These two databases show that patients with some immune-mediated diseases have an increased risk of TB, although we cannot explicitly state the direction of risk or exclude confounding. Further study of these associations is warranted, and these findings may aid TB screening, control and treatment policies.
authors.affiliation: Department of Physiology, Anatomy and Genetics and Medical Research Council Functional Genomics Unit, University of Oxford, Parks Road, Oxford, OX1 3PT, UK.
authors.forename: Sreeram V
authors.initials: SV
authors.lastname: Ramagopalan
authors.forename: Raph
authors.initials: R
authors.lastname: Goldacre
authors.forename: Andrew
authors.initials: A
authors.lastname: Skingsley
authors.forename: Chris
authors.initials: C
authors.lastname: Conlon
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Goldacre
mesh_terms: D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D007154:Immune System Diseases / Q000150:complications*; D008297:Male; D018570:Risk Assessment; D014376:Tuberculosis / Q000453:epidemiology*
references.citation: J Cutan Med Surg. 2009 Sep-Oct;13(5):280-2
references.pmid: 19769839
references.citation: Braz J Infect Dis. 2010 Nov-Dec;14(6):639-40
references.pmid: 21340308
references.citation: BMC Med. 2011 Jan 10;9:1
references.pmid: 21219637
references.citation: J Rheumatol. 2011 Oct;38(10):2218-23
references.pmid: 21844149
references.citation: Int J Tuberc Lung Dis. 2013 Jan;17(1):79-84
references.pmid: 23232007
references.citation: J Neurol Neurosurg Psychiatry. 2010 Feb;81(2):215-21
references.pmid: 19726405
references.citation: Br J Dis Chest. 1979 Apr;73(2):187-91
references.pmid: 119548
references.citation: Ann Rheum Dis. 2007 Oct;66(10):1404-5
references.pmid: 17881668
references.citation: Indian J Pediatr. 2004 Jun;71(6):549-51
references.pmid: 15226569
references.citation: J Dermatol. 2012 Aug;39(8):738-9
references.pmid: 22035185
references.citation: Arthritis Rheum. 2005 Jul;52(7):1986-92
references.pmid: 15986370
references.citation: J Rheumatol. 2008 Jun;35(6):1224-6
references.pmid: 18528954
references.citation: Lancet. 2011 Jul 2;378(9785):57-72
references.pmid: 21420161
references.citation: J Rheumatol. 1996 Dec;23(12):2168-70
references.pmid: 8970060
references.citation: Rheumatol Int. 2012 Jun;32(6):1669-73
references.pmid: 21416237
references.citation: IARC Sci Publ. 1987;(82):1-406
references.pmid: 3329634
references.citation: Clin Rev Allergy Immunol. 2010 Apr;38(2-3):169-77
references.pmid: 19543859
references.citation: Thorax. 2007 Jan;62(1):23-8
references.pmid: 17047199
references.citation: J Epidemiol Community Health. 2012 Jun;66(6):519-23
references.pmid: 21109542
references.citation: J Med Case Rep. 2008 Jan 31;2:32
references.pmid: 18237424
references.citation: Clin Rev Allergy Immunol. 2010 Apr;38(2-3):163-8
references.pmid: 19548122
references.citation: J Biol Regul Homeost Agents. 2011 Apr-Jun;25(2):213-20
references.pmid: 21880210
references.citation: Clin Gastroenterol Hepatol. 2007 Sep;5(9):1070-5
references.pmid: 17627901
references.citation: S Afr Med J. 2012 Sep 07;102(10):802-4
references.pmid: 23034210
references.citation: Clin Med Res. 2008 May;6(1):29
references.pmid: 18591375
references.citation: Acta Neurol Scand. 1981 Feb;63(2):131-5
references.pmid: 7211178
references.citation: Int Urol Nephrol. 2013 Dec;45(6):1773-7
references.pmid: 22826144