Diabetic trends and associated mortality in tuberculosis patients in Texas, a large population-based analysis

Cause of death in patients with tuberculosis: A study based on epidemiological and autopsy records of Western Norway 1931-47

BACKGROUND

Without treatment, nearly 50 % of tuberculosis (TB) patients die. World Health Organization's definition of TB deaths does not take into consideration whether the cause of death was TB or other non-TB co-morbid conditions. We aimed to improve our knowledge of the causes of death in patients with TB.

METHODS

Single-center retrospective study conducted at Gade Institute of Pathology, Haukeland University Hospital, Bergen, Norway. Autopsy data of 269 patients with TB was collected from autopsy journals, and epidemiological data was collected from Norwegian Official Statistics books for period 1931-1947.

RESULTS

Of all TB deaths reported in epidemiological reports, pulmonary TB accounted for 81 % and extrapulmonary TB for 19 %. However, in autopsy records, only 21 % of cases with active pulmonary TB died because of TB. Extrapulmonary involvement was significantly associated with higher mortality (OR EPTB as compared to PTB; 3.27, CI 1.91 - 5.61) and constituted 79 % of deaths attributable to TB. A significant burden of extrapulmonary TB was found in autopsy records (63 %), while in epidemiological records, only 4 % of cases were reported.

CONCLUSIONS

Extrapulmonary involvement was a predictor of mortality due to TB in hospitalized TB patients. The contribution of extrapulmonary TB to TB mortality seems to be underestimated because extrapulmonary TB largely remains underdiagnosed and underreported in epidemiological data.

Are Ethiopian health facilities providing diabetes services capable of managing tuberculosis? Policy implications for introducing diabetes and tuberculosis collaborative care

OBJECTIVE

This study aimed to assess the availability and preparedness of health facilities offering diabetes mellitus (DM) to manage tuberculosis (TB) in Ethiopia.

DESIGN

Secondary data analysis of institution-based cross-sectional national survey data.

SETTING

Data were obtained from the 2021-2022 Ethiopian Service Provision Assessment (ESPA) survey which includes all active health facilities in Ethiopia.

PARTICIPANTS

This study included all health facilities that provide DM services (both diagnosis and treatment) and recently collected DM data during the 2021-2022 ESPA survey.

OUTCOME MEASURES

The service availability was computed as the percentage of facilities offering DM services to provide TB management. The preparedness of these facilities for managing TB was measured using three service tracer indicators (staff training and guidelines, diagnostics and essential medicines used in TB management) defined by the WHO Service Availability and Readiness Assessment Manual. The extent of preparedness was categorised as low level (<50%), moderate level (≥50% to 75%) and high level (≥75%). A descriptive statistic was employed to present the study findings.

RESULTS

Only 170 out of 338 facilities were reported to provide DM services across the country, with 136 (70%) also offering TB management services. Among these facilities, the majority were health centres (n=82; 60.1%), publicly owned (n=98; 72.0%), rural (n=83; 60.7%) and located in the Oromia region (n=53; 39.0%). Regarding preparedness, facilities offering DM services had an overall moderate to high preparedness for managing TB, with 47 (27.5%), 53 (31.1%) and 70 (41.3%) facilities classified as low-level, moderate-level and high-level preparedness, respectively. Specifically, these facilities were less prepared in the domains of 'trained staff and guidelines' and 'diagnostics', but had better preparedness in providing first-line TB drugs, with an overall score of 79.7%.

CONCLUSIONS

Although the percentage availability of TB services in facilities offering DM services and their preparedness was unsatisfactory compared with WHO standards, Ethiopia has a greater capacity to implement WHO strategies to reduce the burden of TB-DM comorbidity. However, given the high epidemiological risk and the high burden of both diseases in the country, our findings emphasise the urgent necessity to establish and implement a collaborative TB-DM care plan to integrate TB services within facilities providing DM care.

Prevalence and associated factors of diabetes mellitus among patients with tuberculosis in South Korea from 2011 to 2018: a nationwide cohort study

OBJECTIVES

This study aimed to identify the prevalence of diabetes mellitus (DM) among patients with tuberculosis (TB) using a nationwide cohort in South Korea.

DESIGN

A retrospective cohort study.

SETTING

This study used the Korean Tuberculosis and Post-Tuberculosis cohort, which was constructed by linking the Korean National Tuberculosis Surveillance, National Health Information Database (NHID) and Statistics Korea data for the causes of death.

PARTICIPANTS

During the study period, all notified patients with TB with at least one claim in the NHID were included. Exclusion criteria were age less than 20 years, drug resistance, initiation of TB treatment before the study period and missing values in covariates.

OUTCOME MEASURES

DM was defined as having at least two claims of the International Classification of Diseases (ICD) code for DM or at least one claim of the ICD code for DM and prescription of any antidiabetic drugs. Newly diagnosed DM (nDM) and previously diagnosed DM (pDM) were defined as DM diagnosed after and before TB diagnosis, respectively.

RESULTS

A total of 26.8% (70 119) of patients were diagnosed with DM. The age-standardised prevalence increased as age increased or income decreased. Patients with DM were more likely to be men, older, had the lowest income group, had more acid-fast bacilli smear and culture positivity, had a higher Charlson Comorbidity Index score and had more comorbidities compared with patients without DM. Approximately 12.5% (8823) patients had nDM and 87.4% (61 296) had pDM among those with TB-DM.

CONCLUSIONS

The prevalence of DM among patients with TB was considerably high in Korea. To achieve the goal of TB control and improve the health outcomes of both TB and DM, integrated screening of TB and DM and care delivery in clinical practice are necessary.

Forecasting tuberculosis using diabetes-related google trends data

Online activity-based data can be used to aid infectious disease forecasting. Our aim was to exploit the converging nature of the tuberculosis (TB) and diabetes epidemics to forecast TB case numbers. Thus, we extended TB prediction models based on traditional data with diabetes-related Google searches. We obtained data on the weekly case numbers of TB in Germany from June 8th, 2014, to May 5th, 2019. Internet search data were obtained from a Google Trends (GTD) search for 'diabetes' to the corresponding interval. A seasonal autoregressive moving average (SARIMA) model (0,1,1) (1,0,0) [52] was selected to describe the weekly TB case numbers with and without GTD as an external regressor. We cross-validated the SARIMA models to obtain the root mean squared errors (RMSE). We repeated this procedure with autoregressive feed-forward neural network (NNAR) models using 5-fold cross-validation. To simulate a data-poor surveillance setting, we also tested traditional and GTD-extended models against a hold-out dataset using a decreased 52-week-long period with missing values for training. Cross-validation resulted in an RMSE of 20.83 for the traditional model and 18.56 for the GTD-extended model. Cross-validation of the NNAR models showed a mean RMSE of 19.49 for the traditional model and 18.99 for the GTD-extended model. When we tested the models trained on a decreased dataset with missing values, the GTD-extended models achieved significantly better prediction than the traditional models (p < 0.001). The GTD-extended models outperformed the traditional models in all assessed model evaluation parameters. Using online activity-based data regarding diabetes can improve TB forecasting, but further validation is warranted.