title: The global relationship between the prevalence of diabetes mellitus and incidence of tuberculosis: 2000-2012.
abstract: BACKGROUND
  The dual burden of tuberculosis (TB) and diabetes mellitus (DM) has increased over the past decade with DM prevalence increasing in countries already afflicted with a high burden of TB. The coexistence of the two conditions presents a serious threat to global public health.
  
  
  OBJECTIVE
  The present study examines the global relationship between the prevalence of DM and the incidence of TB to evaluate their coexistence worldwide and their contribution to one another.
  
  
  METHODS
  This is an ecological longitudinal study covering the period between years 2000 to 2012. We utilized data from the WHO and World Bank sources and International Diabetes Federation to estimate prevalence of DM (%) and the incidence of TB (per 100,000). Measures of central tendency and dispersion as well as the harmonic mean and linear regression were used for different WHO regions. The association between DM prevalence and TB incidence was examined by quartile of DM prevalence.
  
  
  RESULTS
  The worldwide average (±S.D.) prevalence of DM within the study period was 6.6±3.8% whereas TB incidence was 135.0±190.5 per 100,000. DM prevalence was highest in the Eastern Mediterranean (8.3±4.1) and West Pacific (8.2±5.6) regions and lowest in the Africa (3.5±2.6). TB incidence was highest in Africa (313.1±275.9 per 100,000) and South-East Asia (216.7±124.9) and lowest in the European (46.5±68.6) and American (47.2±52.9) regions. Only countries with high DM prevalence (>7.6%) showed a significant positive association with TB incidence (r=0.17, p=0.013).
  
  
  CONCLUSIONS
  A positive association between DM and TB may exist in some - but not all - world regions, a dual burden that necessitates identifying the nature of this coexistence to assist in developing public health approaches that curb their rising burden.
authors.affiliation: Office of Biotechnology, Genomics and Population Health, Public Health Agency of Canada Toronto, ON Canada. alaa.badawi@phac-aspc.gc.ca.
authors.forename: Alaa
authors.initials: A
authors.lastname: Badawi
authors.forename: Suzy
authors.initials: S
authors.lastname: Sayegh
authors.forename: Mohamed
authors.initials: M
authors.lastname: Sallam
authors.forename: Eman
authors.initials: E
authors.lastname: Sadoun
authors.forename: Mohamed
authors.initials: M
authors.lastname: Al-Thani
authors.forename: Muhammad Wasif
authors.initials: MW
authors.lastname: Alam
authors.forename: Paul
authors.initials: P
authors.lastname: Arora
mesh_terms: D015897:Comorbidity; D017281:Cost of Illness; D003920:Diabetes Mellitus / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D038622:Internationality; D008137:Longitudinal Studies; D015995:Prevalence; D014376:Tuberculosis / Q000453:epidemiology*