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).Conclusion: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.
Highlights
An association between tuberculosis (TB) and diabetes mellitus (DM) has been recognized since the Roman era where it was indicated that DM increases the individual’s susceptibility to TB infection (Cooper et al, 1951; Ferrara, 1952; Brock, 1957; Dixon, 2007)
DM prevalence was highest in the Eastern Mediterranean (8.3±4.1) and
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
Summary
An association between tuberculosis (TB) and diabetes mellitus (DM) has been recognized since the Roman era where it was indicated that DM increases the individual’s susceptibility to TB infection (Cooper et al, 1951; Ferrara, 1952; Brock, 1957; Dixon, 2007). It is estimated that one-third of the world population is infected with latent TB, where individuals are at risk of developing the active disease, those with an impaired or compromised immune system (Corbett et al, 2003). These high rates of disease incidence render TB as a major public health problem in many developing low- to middle-income countries and regions such as those in Africa and Asia. 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
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