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Post-tuberculosis incidence of diabetes, myocardial infarction, and stroke: Retrospective cohort analysis of patients formerly treated for tuberculosis in Taiwan, 2002-2013.

ABSTRACT: OBJECTIVES:To estimate the incidence of diabetes, acute myocardial infarction (AMI), and stroke; and to determine factors associated with diabetes, AMI, and stroke incidence among patients previously treated for tuberculosis (TB) disease. METHODS:A retrospective cohort study was conducted among non-pediatric TB patients registered in the Taiwan National Health Insurance Research Database (NHIRD) from 2002-2013. Diabetes, AMI, and stroke incidence were defined by International Classification of Diseases (ICD)-9 codes, drug prescriptions, and records of patient's clinic visits. Cox proportional hazard models were used to estimate the hazard rate ratio (HR) of incident diabetes, AMI, and stroke. RESULTS:From 2002-2013, there were 157,444 patients treated for TB registered in NHIRD. Among 129,453 patients with no prior history of diabetes, the age-adjusted incidence rate (IR) of diabetes was 3.85 (95%CI 3.70-4.01) per 1000 person-years. Among 143,646 patients with no prior history of AMI, the age-adjusted IR of AMI as 3.26 (95%CI 3.13-3.40). Among 118,774 patients with no prior history of stroke, the age-adjusted IR of stroke was 16.08 (95%CI 15.76-16.32). CONCLUSIONS:Chronic non-communicable disease risk factors like dyslipidemia, hypertension, and chronic kidney disease diagnosed before time of TB diagnosis were predictive of diabetes, AMI, and stroke incidence.

SUBMITTER: Salindri AD

PROVIDER: S-EPMC6736631 | biostudies-literature | 2019 Jul

REPOSITORIES: biostudies-literature

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Post-tuberculosis incidence of diabetes, myocardial infarction, and stroke: Retrospective cohort analysis of patients formerly treated for tuberculosis in Taiwan, 2002-2013.

Salindri Argita D AD Wang Jann-Yuan JY Lin Hsien-Ho HH Magee Matthew J MJ

International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases 20190511

<h4>Objectives</h4>To estimate the incidence of diabetes, acute myocardial infarction (AMI), and stroke; and to determine factors associated with diabetes, AMI, and stroke incidence among patients previously treated for tuberculosis (TB) disease.<h4>Methods</h4>A retrospective cohort study was conducted among non-pediatric TB patients registered in the Taiwan National Health Insurance Research Database (NHIRD) from 2002-2013. Diabetes, AMI, and stroke incidence were defined by International Clas ...[more]

PMID: 31085315

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Project description:IntroductionTuberculosis is one of the main infectious diseases threatening global health, which is also the main cause of death from a single source of infection (above HIV/AIDS). China is a country with a high burden of tuberculosis in the world, ranking only behind India and Indonesia. However, there are few ecological studies on the burden of tuberculosis in China. This study aims to provide more research basis for the government to formulate tuberculosis policies by exploring the ecological factors associated with the incidence of tuberculosis, so as to achieve the goal of eliminating tuberculosis by 2030.MethodsWe collected data on the incidence of tuberculosis and ecological factors of 31 provinces, autonomous regions, and municipalities in Mainland China (excluding Taiwan, Hong Kong, and Macau) from 2002 to 2018. We constructed a framework of ecological factors affecting the incidence, which consists of 5 secondary indicators and 35 tertiary indicators. And we construct a dynamic panel data model based on the Lasso Regression to select variables to test the effect of each ecological factor on the incidence.ResultsAmong the 35 tertiary indicators, economy 3,4,6,7, environment 1, recourses 1,3, demography 3, and lifecare 2,4,8,9,13 passed the significance test at the 1% level, economy 1,2,5, environment 2,9, lifecare 6,12 passed the significance test at the 5% level, lifecare 10 passed the significance test at the 10% level. Only economy 5 and economy 6 have a positive impact on the incidence, other statistically significant ecological indicators are negatively correlated with the incidence.ConclusionsOur study indicated that many ecological factors, including residents' income, unemployment rate, educational level, medical resources, population density, sunshine duration and dietary structure, are closely related to the incidence of tuberculosis. These findings contribute the government to taking targeted measures for tuberculosis prevention and control, including improving the level of economic development, increasing employment, expanding the scale of enrollment in colleges and universities, and ensuring that the prices of sources of animal protein are reasonable to meet the residents' intake of protein.

Project description:Background and aimsPatients with kidney failure have a higher risk of cardiovascular disease compared with the general population. Whilst temporal trends of myocardial infarction and stroke are declining in the general population, these have not been evaluated in patients with kidney failure. This study aimed to describe national trends in the incidence, treatment, and outcomes of myocardial infarction and stroke in patients with kidney failure (i.e. on dialysis or with a kidney transplant) over a 20-year period, stratified by age and sex.MethodsIn this retrospective national data linkage study, all patients with kidney failure in Scotland (UK) receiving kidney replacement therapy between January 1996 and December 2016 were linked to national hospitalization, prescribing, and death records. The primary outcomes were the incidence of myocardial infarction and stroke, and subsequent cardiovascular death. Generalized additive models were constructed to estimate age-standardized, sex-stratified incidence rates and trends in cardiovascular and all-cause death.ResultsAmongst 16 050 patients with kidney failure [52 (SD 15) years; 41.5% women], there were 1992 [66 (SD 12) years; 34.8% women] and 996 [65 (SD 13) years; 45.1% women] incident myocardial infarctions and strokes, respectively, between January 1996 and December 2016. During this period, the age-standardized incidence of myocardial infarction per 100 000 decreased in men {from 4376 [95% confidence interval (CI) 3998-4785] to 1835 (95% CI 1692-1988)} and women [from 3268 (95% CI 2982-3593) to 1369 (95% CI 1257-1491)]. Similarly, the age-standardized incidence of stroke per 100 000 also decreased in men [from 1978 (95% CI 1795-2175) to 799 (95% CI 729-875)] and women [from 2234 (95% CI 2031-2468) to 903 (95% CI 824-990)]. Compared with the general population, the incidence of myocardial infarction was four- to eight-fold higher in patients with kidney failure, whilst for stroke it was two- to four-fold higher. The use of evidence-based cardioprotective treatment increased over the study period, and the predicted probability of cardiovascular death within 1 year of myocardial infarction for a 66-year-old patient with kidney failure (mean age of the cohort) fell in men (76.6% to 38.6%) and women (76.8% to 38.8%), and also decreased in both sexes following stroke (men, from 63.5% to 41.4%; women, from 67.6% to 45.8%).ConclusionsThe incidence of myocardial infarction and stroke has halved in patients with kidney failure over the past 20 years but remains significantly higher than in the general population. Despite improvements in treatment and outcomes, the prognosis of these patients following myocardial infarction and stroke remains poor.

Dataset Information

Post-tuberculosis incidence of diabetes, myocardial infarction, and stroke: Retrospective cohort analysis of patients formerly treated for tuberculosis in Taiwan, 2002-2013.

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Post-tuberculosis incidence of diabetes, myocardial infarction, and stroke: Retrospective cohort analysis of patients formerly treated for tuberculosis in Taiwan, 2002-2013.

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