Factors associated with tuberculosis in a population of diabetics: A case-control study

Leal, Marcelle Lemos; Maciel, Ethel Leonor Nóia; Cade, Nágela Valadão

doi:10.1590/1413-81232018249.30392017

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ARTICLE • Ciênc. saúde coletiva 24 (9) • Sept 2019 • https://doi.org/10.1590/1413-81232018249.30392017 copy

Factors associated with tuberculosis in a population of diabetics: A case-control study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This study analyzed the factors associated with tuberculosis in diabetics seen at health units of Vitória, ES, Brazil. This is a case-control study of 45 cases of diabetics seen in the 30 units of the municipality and reported in the SINAN with a diagnosis of tuberculosis in the 2007-2013 period and 90 cases of diabetic controls. We used data from the SINAN, the Health Information System of Vitória, and the Central Municipal Laboratory, as well a structured interview. Bivariate and multivariate analyses were performed, using logistic regression with the significant variables (p < 0.05). The case group presented a higher frequency of health-damaging life habits as compared to the control group, such as compulsive drinking (p < 0.001) and tobacco smoking (p = 0.060), as well as worse biochemical parameters, such as fasting blood sugar (p < 0.001) and glycosylated hemoglobin (p = 0.034). Regular drinking (OR 6.612, CI 2,151-20.330), previous contact with people with tuberculosis (OR 4.418, CI 1.678-11.631), and fasting blood sugar (OR 1.017, CI 1.007-1.026) were associated with tuberculosis in diabetics. The study reveals that poorer lifestyle habits and glycemic control and previous contact with active tuberculosis increase the chance of diabetics developing tuberculosis.

Key words
Diabetes mellitus; Tuberculosis; Case-control studies; Epidemiology

Variables	Case (n = 45)		Control (n = 90)		p-value
Variables	n	%	n	%	p-value
Race/Color					0.030
White	7	15.6	29	33.3
Non-white	38	84.4	58	66.7
Schooling					0.459
< 4 years	28	62.2	47	52.2
4 to 8 years	9	20.0	19	21.1
> 8 years	8	17.8	24	26.7
Socioeconomic classification					0.610
Class A/B	5	11.1	15	16.9
Class C	31	68.9	60	67.4
Class D/E	9	20.0	14	15.7
Alcohol consumption					0.009^ Maximum likelihood ratio.
Regular intake	16	35.6	12	13.3
Sporadic intake	2	4.4	10	11.1
Never drank/Does not drink currently	27	60.0	68	75.6
Presence of drinking compulsion					< 0.001^ Maximum likelihood ratio.
Drinking compulsion	16	35.6	8	8.9
No compulsion	2	4.4	14	15.6
Never drank/Does not drink currently	27	60.0	68	75.6
Smoking					0.060
Used to smoke but quit	13	28.9	34	37.8
Smokes currently	15	33.3	14	15.6
Never smoke	17	37.8	42	46.7
Other drug use					0.110^* * Fisher's exact test.
Yes	3	6.7	1	1.1
No	42	93.3	88	98.9
Contact with people with TB					0.001
Yes	21	56.8	21	25.0
No	16	43.2	63	75.0
Type of contact					0.420^ Maximum likelihood ratio.
Family	14	66.7	13	61.9
Friendship	3	14.3	6	28.6
Work	4	19.0	2	9.5
Medication for diabetes					0.062
Oral hypoglycemic	22	48.9	59	65.6
Oral hypoglycemic and Insulin	23	51.1	31	34.4

Variables	Group	n Case (n = 45) Control (n = 90)	Minimum	Maximum	Median	Mean	SD	p-value
Age	Case	45	24	88	54.00	55.49	11.85	0.371 ^* * T-test for means.
Age	Control	90	25	90	56.50	57.36	11.17	0.371 ^* * T-test for means.
Time of diabetes mellitus in years	Case	45	1	50	9.00	13.22	10.77	0.084 ^ Mann-Whitney test.
Time of diabetes mellitus in years	Control	90	1	50	8.00	10.41	9.58	0.084 ^ Mann-Whitney test.
Number of complications due to diabetes mellitus	Case	45	0	5	1.00	1.00	1.07	0.236 ^ Mann-Whitney test.
Number of complications due to diabetes mellitus	Control	90	0	4	0.00	0.83	1.07	0.236 ^ Mann-Whitney test.
Number of comorbidities	Case	45	0	3	1.00	1.04	0.80	0.596 ^ Mann-Whitney test.
Number of comorbidities	Control	90	0	3	1.00	0.97	0.66	0.596 ^ Mann-Whitney test.
HbA1c¹ 1 HbA1c - Glycosylated hemoglobin.	Case	45	4.95	14,80	8.60	8.81	2.32	0.034 ^ Mann-Whitney test.
HbA1c¹ 1 HbA1c - Glycosylated hemoglobin.	Control	85	5.21	13,30	7.60	7,86	1.83	0.034 ^ Mann-Whitney test.
Fasting blood sugar	Case	45	91.38	444.25	174.53	195.12	77.96	<0.001 ^ Mann-Whitney test.
Fasting blood sugar	Control	90	80.50	248.55	138.16	145.04	36.92	<0.001 ^ Mann-Whitney test.
HbA1c1 before TB	Case	22	5.70	12.69	9.58	9.43	2.06	0.002 ^ Mann-Whitney test.
HbA1c1 before TB	Control	85	5.21	13,30	7.60	7,86	1.83	0.002 ^ Mann-Whitney test.
Fasting blood sugar before TB	Case	31	74.00	338.00	192.50	193.17	1.83	0.001 ^ Mann-Whitney test.
Fasting blood sugar before TB	Control	90	80.50	248.55	138.16	145.04	36.92	0.001 ^ Mann-Whitney test.
HbA1c1 after TB	Case	39	4.95	13,30	8.17	8.36	2.30	0.363 ^ Mann-Whitney test.
HbA1c1 after TB	Control	85	5.21	13,30	7.60	7,86	1.83	0.363 ^ Mann-Whitney test.
Fasting blood sugar after TB	Case	40	90.90	736.60	166.96	199.64	118.59	0.003 ^ Mann-Whitney test.
Fasting blood sugar after TB	Control	90	80.50	248.55	138.16	145.04	36.92	0.003 ^ Mann-Whitney test.

Variables	Multivariate analysis
Variables	p-value	Adjusted OR	95% CI
Drinking
Regular intake	0.001	6.612	2,151 - 20,330
Sporadic intake	0.346	0.308	0.027 - 3.563
Never drank/ Does not drink currently	-	-	-
Contact with person with tuberculosis
Yes	0.003	4.418	1.678 - 11.631
No	-	-	-
Fasting blood sugar (mean from	0.000	1.017	1.007 - 1.026

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[1] Collaborations

ML Leal carried out the conception and design of the study, data collection analysis and interpretation, and writing of the article; she is responsible for the accuracy and integrity of any part of the work. ELN Maciel contributed with data analysis and interpretation and in the relevant critical review of the intellectual content. NV Cade participated in the conception and design of the study and contributed in data analysis and interpretation and critical-intellectual review of the article.