Tuberculosis and Diabetes in Southern Mexico

Tuberculosis and Diabetes in Southern Mexico Alfredo Ponce-de-Leon , MD 1 , Ma. de Lourdes Garcia-Garcia , MD, DRSC 2 , Ma. Cecilia Garcia-Sancho , MD, MSC 3 , Francisco J. Gomez-Perez , MD 1 , Jose Luis Valdespino-Gomez , MD, MPH 2 , Gustavo Olaiz-Fernandez , MD 2 , Rosalba Rojas , MD 2 , Leticia Ferreyra-Reyes , MD 2 , Bulmaro Cano-Arellano , BA 2 , Miriam Bobadilla , DRSC 1 , Peter M. Small , MD 4 and Jose Sifuentes-Osornio , MD 1 1 National Institute of Medical Sciences and Nutrition, Salvador Zubirán, Distrito Federal, Mexico 2 National Institute of Public Health, Cuernavaca, Mexico 3 National Institute of Respiratory Diseases, Distrito Federal, Mexico 4 Stanford University, Stanford, California Address correspondence and reprint requests to Ma. de Lourdes García-García, Instituto Nacional de Salud Pública, Ave. Universidad No. 655, Cuernavaca, México, 62508. E-mail: garcigar{at}correo.insp.mx Abstract OBJECTIVE —To determine the impact of diabetes on the rates of tuberculosis in a region where both diseases are prevalent. RESEARCH DESIGN AND METHODS —Data from a population-based cohort of patients with pulmonary tuberculosis undergoing clinical and mycobacteriologic evaluation (isolation, identification, drug-susceptibility testing, and IS6110-based genotyping and spoligotyping) were linked to the 2000 National Health Survey (ENSA2000), a national probabilistic, polystage, stratified, cluster household survey of the civilian, noninstitutionalized population of Mexico. RESULTS —From March 1995 to March 2003, 581 patients with Mycobacterium tuberculosis culture and fingerprint were diagnosed, 29.6% of whom had been diagnosed previously with diabetes by a physician. According to the ENSA2000, the estimated prevalence of diabetes in the study area was 5.3% (95% CI 4.1–6.5). The estimated rates of tuberculosis for the study area were greater for patients with diabetes than for nondiabetic individuals (209.5 vs. 30.7 per 100,000 person-years, P < 0.0001). CONCLUSIONS —In this setting, the rate of tuberculosis was increased 6.8-fold (95% CI 5.7–8.2, P < 0.0001) in patients with diabetes due to increases in both reactivated and recently transmitted infection. Comorbidity with diabetes may increase tuberculosis rates as much as coinfection with human immunodeficiency virus (HIV), with important implications for the allocation of health care resources. ENSA2000, 2000 National Health Survey RFLP, restriction fragment-length polymorphism Footnotes A table elsewh