Hostname: page-component-76fb5796d-skm99 Total loading time: 0 Render date: 2024-04-26T10:32:16.465Z Has data issue: false hasContentIssue false
  • English
  • Français

Co-existence of diabetes and TB among adults in India: a study based on National Family Health Survey data

Published online by Cambridge University Press:  22 September 2020

Apyayee Sil Open the ORCID record for Apyayee Sil [Opens in a new window] ,
Dinabandhu Patra ,
Preeti Dhillon Open the ORCID record for Preeti Dhillon [Opens in a new window]  and
Padmanesan Narasimhan
Apyayee Sil
Affiliation:
Department of Mathematical Demography and Statistics, International Institute for Population Sciences, Mumbai, India
Dinabandhu Patra
Affiliation:
Department of Mathematical Demography and Statistics, International Institute for Population Sciences, Mumbai, India
Preeti Dhillon*
Affiliation:
Department of Mathematical Demography and Statistics, International Institute for Population Sciences, Mumbai, India
Padmanesan Narasimhan
Affiliation:
School of Public Health & Community Medicine, UNSW Medicine, Sydney, NSW, Australia
*
*Corresponding author. Email: pdhillon.iips@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Multiple studies suggest that diabetes mellitus (DM) is a potential risk factor for tuberculosis (TB) development and treatment, especially in low- and middle-income countries. The study aimed to test concomitancy between DM and TB among adults in India. Data were from the 2015–16 National Family Health Survey (NFHS-4). The study sample comprised 107,575 men aged 15–54 and 677,292 women aged 15–49 for which data on DM status were available in the survey. The association between state-level prevalence of TB and DM was examined and robust Poisson regression analysis applied to examine the effect of DM on TB. A high prevalence of TB was observed among individuals with diabetes in India in 2015–16. A total of 866 per 100,000 men and 405 per 100,000 women who self-reported having diabetes also had TB; among those who self-reported not having diabetes the ratios were 407 per 100,000 men and 241 per 100,000 women. The risk of having TB among those who self-reported having DM was higher for both men (2.03, 95% CI: 1.26, 3.28) and women (1.79, 95% CI: 1.48, 2.49) than for those who did not self-report having DM. Adults who were diagnosed with diabetes (including pre-diabetes) also had a higher rate of TB (477 per 100,000 men and 331 per 100,000 women) than those who were not diagnosed (410 per 100,000 men and 239 per 100,000 women). Adults from poor families, with lower BMIs, lower levels of literacy and who were not working had a higher risk of TB–DM co-morbidity. The state-level pattern of co-morbidity, the under-reporting of DM (undiagnosed) and TB stigmatization are discussed. The study confirms that diabetes is an important co-morbid feature with TB in India, and reinforces the need to raise awareness on screening for the co-existence of DM and TB with integrated health programmes for the two conditions.

Keywords

TuberculosisDiabetesCo-morbidity
Type
Research Article
Information
Journal of Biosocial Science , Volume 53 , Issue 5 , September 2021 , pp. 758 - 772
Copyright
© The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abdelbary, BE, Garcia-Viveros, M, Ramirez-Oropesa, H, Rahbar, MH and Restrepo, BI (2016) TB-diabetes epidemiology in the border and non-border regions of Tamaulipas, Mexico. Tuberculosis 101, S124–S134.CrossRefGoogle Scholar
Agarwal, AK, Ginisha, G, Preeti, G, Dwivedi, S and Swamai, P (2016) The association between diabetes and tuberculosis may be the next challenge for global TB control worldwide. Indian Journal of Endocrinology Metabolism 20(5), 732.CrossRefGoogle Scholar
Akhtar, SN and Dhillon, P (2017) Prevalence of diagnosed diabetes and associated risk factors: evidence from the large-scale surveys in India. Journal of Social Health and Diabetes 5, 28–36.Google Scholar
Alkabab, YM, Al-Abdely, HM and Heysell, SK (2015) Diabetes-related TB in the Middle East: an urgent need for regional research. International Journal of Infectious Diseases 40, 64–70.CrossRefGoogle ScholarPubMed
Baghaei, P, Marjani, M, Javanmard, P, Tabarsi, P and Masjedi, MR (2013) Diabetes mellitus and TB facts and controversies. Journal of Diabetes and Metabolic Disorders 12(1), 58.CrossRefGoogle ScholarPubMed
Baker, MA, Harries, AD, Jeon, CY, Hart, JE, Kapur, A, Lönnroth, K et al. (2011) The impact of diabetes on TB treatment outcomes: a systematic review. BMC Medicine 9(1), 81.CrossRefGoogle Scholar
Boum, Y, Atwine, D, Orikiriza, P, Assimwe, J, Page, AL, Mwanga-Amumpaire, J and Bonnet, M (2014) Male gender is independently associated with pulmonary tuberculosis among sputum and non-sputum producers people with presumptive tuberculosis in Southwestern Uganda. BMC Infectious Diseases 14(1), 638.CrossRefGoogle ScholarPubMed
Claypool, KT, Chung, MK, Deonarine, A, Gregg, EW and Patel, CJ (2020) Characteristics of undiagnosed diabetes in men and women under the age of 50 years in the Indian subcontinent: the National Family Health Survey (NFHS-4)/Demographic Health Survey 2015–2016. BMJ Open Diabetes Research & Care 8(1), e000965.CrossRefGoogle ScholarPubMed
Desalu, OO, Adeoti, AO, Fadeyi, A, Salami, AK, Fawibe, AE and Oyedepo, OO (2013) Awareness of the warning signs, risk factors, and treatment for TB among urban Nigerians. TB Research and Treatment Disorders 12(1), 58.Google Scholar
Falagas, ME and Kompoti, M (2006) Obesity and infection. The Lancet Infectious Disease 6(7), 438–446.CrossRefGoogle ScholarPubMed
Francisco, J, Oliveira, O, Felgueiras, Ó, Gaio, AR and Duarte, R (2017) How much is too much alcohol in TB? European Respiratory Journal 49(1), 1601468.CrossRefGoogle Scholar
Gauld, WR and Lyall, A (1947) TB as complication of diabetes mellitus. BMJ 1(4506), 677.CrossRefGoogle Scholar
Ghosh, K, Dhillon, P and Agrawal, G (2019) Prevalence and detecting spatial clustering of diabetes at the district level in India. Journal of Public Health, https://doi.org/10.1007/s10389-019-01072-6 Google Scholar
Gilani, SI and Khurram, M (2012) Perception of TB in Pakistan: findings of a nation-wide survey. Journal of Pakistan Medical Association 62(2), 116–120.Google ScholarPubMed
Hochberg, NS and Horsburgh, JCR (2013) Prevention of TB in older adults in the United States: obstacles and opportunities. Clinical Infectious Diseases 56(9), 1240–1247.CrossRefGoogle Scholar
Horton, KC, MacPherson, P, Houben, RM, White, RG and Corbett, EL (2016) Sex differences in tuberculosis burden and notifications in low-and middle-income countries: a systematic review and meta-analysis. PLoS Medicine 13(9), e1002119 CrossRefGoogle ScholarPubMed
IDF (2015) IDF Diabetes Atlas, 7th edition. International Diabetes Federation. URL: http://www.idf.org/idf-diabetesatlas-seventh-edition (accessed 11th May 2019)Google Scholar
IIPS and ICF (2017) National Family Health Survey (NFHS-4), 2015–16. IIPS, Mumbai, India. URL: http://rchiips.org/NFHS/pdf/NFHS4/India.pdf (accessed 11th May 2019).Google Scholar
Jayawardena, R, Ranasinghe, P, Byrne, NM, Soares, MJ, Katulanda, P and Hills, AP (2012) Prevalence and trends of the diabetes epidemic in South Asia: a systematic review and meta-analysis. BMC Public Health 12(1), 380.CrossRefGoogle ScholarPubMed
Jee, SH, Golub, JE, Jo, J, Park, IS, Ohrr, H and Samet, JM (2009) Smoking and risk of TB incidence, mortality, and recurrence in South Korean men and women. American Journal of Epidemiology 170(12), 1478–1485.CrossRefGoogle Scholar
Jeon, CY and Murray, MB (2008) Diabetes mellitus increases the risk of active TB: a systematic review of 13 observational studies. PLoS Medicine 5(7), e152.CrossRefGoogle ScholarPubMed
Jha, A (2010) An epidemiological study of pulmonary TB in the Field Practice Areas, Dehradun. HNB Garhwal University, Srinagar, India.Google Scholar
Kornfeld, H, West, K, Kane, K, Kumpatla, S, Zacharias, RR, Martinez-Balzano, C et al. (2016) High prevalence and heterogeneity of diabetes in patients with TB in South India: a report from the effects of diabetes on TB severity (EDOTS) study. Chest 149(6), 1501–1508.CrossRefGoogle ScholarPubMed
Kottarath, MD, Mavila, R, Achuthan, V and Nair, S (2015) Prevalence of diabetes mellitus in tuberculosis patients: a hospital based study. International Journal of Research in Medical Sciences 3, 2810–2814.CrossRefGoogle Scholar
Kumpatla, S, Sekar, A, Achanta, S, Sharath, BN, Kumar, AMV, Harries, AD and Viswanathan, V (2013) Characteristics of patients with diabetes screened for tuberculosis in a tertiary care hospital in South India. Public Health Action 3(1), 23–28.CrossRefGoogle Scholar
Kyu, HH, Maddison, ER, Henry, NJ, Mumford, JE, Barber, R, Shields, C et al. (2018) The global burden of tuberculosis: results from the Global Burden of Disease Study 2015. The Lancet Infectious Diseases 18(3), 261–284.CrossRefGoogle Scholar
Malhotra, R, Taneja, DK, Dhingra, VK, Rajpal, S and Mehra, M (2002) Awareness regarding TB in a rural population of Delhi. Indian Journal of Community Medicine 27(2), 62–68.Google Scholar
Mohan, V, Sandeep, S, Deepa, R, Shah, B and Varghese, C (2007) Epidemiology of type 2 diabetes: Indian scenario. Indian Journal of Medical Research 125(3), 217–230.Google ScholarPubMed
Mori, T and Leung, CC (2010) TB in the global aging population. Infectious Disease Clinics 24(3), 751–768.Google ScholarPubMed
Narasimhan, P, Wood, J, MacIntyre, CR and Mathai, D (2013) Risk factors for Tuberculosis. Pulmonary Medicine 2013, 828939.CrossRefGoogle ScholarPubMed
Noureen, F, Rehman, A and Hanif, A (2017) Frequency of hepatotoxicity in pulmonary tuberculosis patients taking anti-tuberculosis therapy. International Journal of Frontier Sciences 1(2), 3–10.CrossRefGoogle Scholar
Ogbera, AO, Kapur, A, Abdur-Razzaq, H, Harries, AD, Ramaiya, K, Adeleye, O et al. (2017) Diagnostic delay and associated factors among patients with pulmonary TB in Kerala. Journal of Family Medicine and Primary Care 6(3), 643–648.Google Scholar
Pacha, A (2019) Why people with diabetes are at a high risk of tuberculosis. The Hindu, URL: https://www.thehindu.com/sci-tech/health/why-people-with-diabetes-are-at-a-high-risk-of-tuberculosis/article26566188.ece (accessed 11th May 2019).Google Scholar
Panjabi, R, Comstock, GW and Golub, JE (2007) Recurrent TB and its risk factors: adequately treated patients are still at high risk. International Journal of Tuberculosis and Lung Disease 11(8), 828–837.Google ScholarPubMed
Pereira, SM, Araújo, GSD, Santos, CADST, Oliveira, MGD and Barreto, ML (2016) Association between diabetes and tuberculosis: case-control study. Revista de saude publica 50, 82.CrossRefGoogle ScholarPubMed
Rajalakshmi, S and Veluchamy, G (1999) Yugi’s pramegam and diebetes mellitus: an analogue. Bulletin of the Indian Institute of History of Medicine 29(1), 83–87.Google Scholar
Rani, M, Bonu, S, Jha, P, Nguyen, SN and Jamjoum, L (2003) Tobacco use in India: prevalence and predictors of smoking and chewing in a national cross sectional household survey. Tobacco Control 12(4), e4–e4.CrossRefGoogle Scholar
Remy, WL (2016) The association between latent tuberculosis infection and diabetes mellitus control in the United States. Thesis, University of Kentucky. URL: https://uknowledge.uky.edu/cph_etds/122 Google Scholar
Restrepo, BI (2018) Diabetes and TB. In Venketaraman, V (ed.) Understanding the Host Immune Response against Mycobacterium TB Infection. Springer, Cham, pp. 1-21.Google Scholar
Restrepo, BI, Camerlin, AJ, Rahbar, MH, Wang, W, Restrepo, MA, Zarate, I et al. (2011) Cross-sectional assessment reveals high diabetes prevalence among newly-diagnosed TB cases. Bulletin of the World Health Organization 89, 352–359.CrossRefGoogle Scholar
Saikia, N and Ram, F (2010) Determinants of adult mortality in India. Asian Population Studies 6(2), 153–171.CrossRefGoogle Scholar
Semunigus, T, Tessema, B, Eshetie, S and Moges, F (2016) Smear positive pulmonary TB and associated factors among homeless individuals in Dessie and Debre Birhan towns, Northeast Ethiopia. Annals of Clinical Microbiology and Antimicrobials 15(1), 50.CrossRefGoogle ScholarPubMed
Sharma, P, Visnegarwala, F and Tripathi, V (2014) Burgeoning double burden of tuberculosis and diabetes in India: magnitude of the problem – strategies and solutions. Clinical Epidemiology and Global Health 2(3), 107–116.CrossRefGoogle Scholar
Siddiqui, AN, Khayyam, KU and Sharma, M (2016) Effect of Diabetes Mellitus on TB treatment outcome and adverse reactions in patients receiving directly observed treatment strategy in India: a prospective study. BioMed Research International 2016, 7273935.CrossRefGoogle ScholarPubMed
Somannavar, S, Ganesan, A, Deepa, M, Datta, M and Mohan, V (2009) Random capillary blood glucose cut points for diabetes and pre-diabetes derived from community-based opportunistic screening in India. Diabetes Care 32(4), 641–643.CrossRefGoogle ScholarPubMed
Stead, WW and To, T (1987) The significance of the tuberculin skin test in elderly persons. Annals of Internal Medicine 107(6), 837–842.CrossRefGoogle ScholarPubMed
Thomas, A, Gopi, PG, Santha, T, Chandrasekaran, V, Subramani, R, Selvakumar, N et al. (2005) Predictors of relapse among pulmonary TB patients treated in a DOTS program in South India. International Journal of TB and Lung Disease 9(5), 556–561.Google Scholar
Viswanathan, V, Kumpatla, S, Aravindalochanan, V, Rajan, R, Chinnasamy, C, Srinivasan, R et al. (2012) Prevalence of diabetes and pre-diabetes and associated risk factors among TB patients in India. PloS One 7(7), e41367.CrossRefGoogle ScholarPubMed
Vukovic, D, Nagorni-Obradovic, L and Bjegovic, V (2008) Knowledge and misconceptions of TB in the general population in Serbia. European Journal of Clinical Microbiology & Infectious Diseases 27(9), 761–767.CrossRefGoogle ScholarPubMed
WHO (2016) Global Report on Diabetes. WHO, Geneva. URL: https://apps.who.int/iris/handle/10665/204871 Google Scholar
Yakaryılmaz, FD and Öztürk, ZA (2017) Treatment of type 2 diabetes mellitus in the elderly. World Journal of Diabetes 8(6), 278.CrossRefGoogle ScholarPubMed
Young, F, Wotton, CJ, Critchley, JA, Unwin, NC and Goldacre, MJ (2010) Increased risk of TB disease in people with diabetes mellitus: record-linkage study in a UK population. Journal of Epidemiology & Community Health 66(6), 519–523.CrossRefGoogle Scholar
Zhang, H, Li, X, Xin, H, Li, H, Li, M, Lu, W et al. (2017) Association of body mass index with the TB infection: a population-based study among 17796 adults in rural China. Scientific Reports 7, 41933.CrossRefGoogle ScholarPubMed
Zou, G (2004) A modified Poisson regression approach to prospective studies with binary data. American Journal of Epidemiology 159(7), 702–706.CrossRefGoogle ScholarPubMed