title: Increased risk of tuberculosis in patients with type 1 diabetes mellitus: results from a population-based cohort study in Taiwan.
abstract: The studies on the risk of tuberculosis (TB) in patients with type 1 diabetes mellitus (T1DM) alone are limited. We examined this relationship using a population-based retrospective cohort study. From claims data of the National Health Insurance system of Taiwan, we identified 5195 patients with T1DM newly diagnosed from 2002 to 2011 and 20,780 randomly selected controls without T1DM, frequency matched by age, sex, and year of diagnosis. Both cohorts were followed up until the end of 2011 to evaluate the risk of TB. The overall incidence of TB was 4.07-fold higher in the T1DM cohort than in the control cohort (1.18 vs 0.29 per 1000 person-years, P < 0.001). Compared with the controls, the Cox model estimated adjusted hazard ratios (HRs) of TB in patients with T1DM were greater in men than in women (4.62 vs 3.59) and in adults than in children (4.06 vs 3.37), but not significant. The adjusted HR was much greater for those with comorbidities than those without comorbidities (14.6 vs 1.62, P < 0.001). Compared with the controls, the patients with T1DM were also more likely to develop TB with multiple emergency room visits (adjusted HR: 116.1, 95% confidence interval [CI] = 43.8-307.4) or hospitalizations (adjusted HR: 86.5, 95% CI = 33.7-222.4). Patients with T1DM are at elevated risks of developing TB with much higher HRs for those with comorbidities, within the first year of diagnosis, and with frequent emergency cares or hospitalizations.
authors.affiliation: Division of Pulmonary and Critical Care Medicine (T-CS, W-CL, W-CC, C-HC, C-YT, T-CH, C-MS, W-HH, C-HL), Department of Internal Medicine, China Medical University Hospital and China Medical University, Taichung; Division of Pulmonary and Critical Care Medicine (T-CS), Department of Internal Medicine, Chu Shang Show Chwan Hospital, Nantou; Institute of Clinical Medical Science (T-CS, F-CS), College of Medicine, China Medical University; Management Office for Health Data (C-LL, F-CS), China Medical University Hospital, Taichung; Division of Nephrology (C-CW), Department of Pediatrics, China Medical University Hospital and China Medical University, Taichung, Taiwan.
authors.forename: Te-Chun
authors.initials: TC
authors.lastname: Shen
authors.forename: Cheng-Li
authors.initials: CL
authors.lastname: Lin
authors.forename: Chang-Ching
authors.initials: CC
authors.lastname: Wei
authors.forename: Wei-Chih
authors.initials: WC
authors.lastname: Liao
authors.forename: Wei-Chun
authors.initials: WC
authors.lastname: Chen
authors.forename: Chia-Hung
authors.initials: CH
authors.lastname: Chen
authors.forename: Chih-Yen
authors.initials: CY
authors.lastname: Tu
authors.forename: Te-Chun
authors.initials: TC
authors.lastname: Hsia
authors.forename: Chuen-Ming
authors.initials: CM
authors.lastname: Shih
authors.forename: Wu-Huei
authors.initials: WH
authors.lastname: Hsu
authors.forename: Chia-Hsiang
authors.initials: CH
authors.lastname: Li
authors.forename: Fung-Chang
authors.initials: FC
authors.lastname: Sung
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016208:Databases, Factual; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology / Q000209:etiology*; D055815:Young Adult