Abstract
Tuberculosis (TB) and depression were major public health issues worldwide and the mutual causative relationships between them were not exhaustive. This study was performed to explore the association between depression, comorbidities, and the risk of pulmonary TB in Taiwan. The cohort study used the database of the Taiwan National Health Insurance Program. The depression group included 34,765 subjects aged 20-84 years with newly diagnosed depression from 2000 to 2012, and the non-depression group included 138,187 randomly selected subjects without depression. Both depression and non-depression groups were matched with respect to sex, age, and comorbidities. We explored the incidence of pulmonary TB at the end of 2013 in both the groups and used multivariable Cox proportional hazards regression model to explore the hazard ratio (HR) and 95% confidence interval (CI) for the risk of pulmonary TB associated with depression. The overall incidence of pulmonary TB was 1.16-fold greater in the depression group than that in the non-depression group (1.52 vs. 1.31 per 1,000 person-years, 95% CI 1.12, 1.21). The multivariable Cox proportional hazards regression analysis revealed that the adjusted HR of pulmonary TB was 1.15 for the depression group (95% CI 1.03, 1.28), compared with the non-depression group. Depression is associated with 1.15-fold increased hazard of pulmonary TB in Taiwan.
Highlights
Tuberculosis (TB) is a major public health issue with a relatively high incidence and prevalence
Data are presented as the number of subjects in each group with percentages given in parentheses, or mean with SD given in parentheses. aChi-square test, bFisher-exact test, and ct-test comparing subjects with and without depression
Previous articles have revealed that diabetes, splenectomy, appendectomy, and gastrectomy correlate with the increasing risk of pulmonary TB in Taiwan, compatible with the results of our study [3, 48, 59, 60]
Summary
Tuberculosis (TB) is a major public health issue with a relatively high incidence and prevalence. It is a chronic infectious multi-systemic disease which has burdened the socioeconomic and health-care aspect in the past few decades. In Taiwan, the annual incidence was 63.7 and 53 cases per 100,000 person-years in 2006 and 2012 [3, 4]. We observed the declined trend of TB incidence over the past 50 years in Taiwan after efforts of Taiwan Centers for Disease Control (CDC) [5]. All efforts for recent decades decreasing incidence of TB in Taiwan by Taiwan CDC, including directly observed treatment, short course (DOTS) for sputum smear-positive patients, DOTSplus strategy for multidrug resistance tuberculosis patients and profound treatment for latent TB children. Until 2009 in Taiwan, the treatment success rate is up to 87% [7]
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