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Lookup NU author(s): Professor Nigel Unwin
BackgroundTuberculosis (TB) remains a major cause of mortality in developing countries, and in these countries diabetes prevalence is increasing rapidly. Diabetes increases the risk of TB. Our aim was to assess the potential impact of diabetes as a risk factor for incident pulmonary tuberculosis, using India as an example. MethodsWe constructed an epidemiological model using data on tuberculosis incidence, diabetes prevalence, population structure, and relative risk of tuberculosis associated with diabetes. We evaluated the contribution made by diabetes to both tuberculosis incidence, and to the difference between tuberculosis incidence in urban and rural areas. ResultsIn India in 2000 there were an estimated 20.7 million adults with diabetes, and 900,000 incident adult cases of pulmonary tuberculosis. Our calculations suggest that diabetes accounts for 14.8% (uncertainty range 7.1% to 23.8%) of pulmonary tuberculosis and 20.2% (8.3% to 41.9%) of smear-positive (i.e. infectious) tuberculosis. We estimate that the increased diabetes prevalence in urban areas is associated with a 15.2% greater smear-positive tuberculosis incidence in urban than rural areas – over a fifth of the estimated total difference. ConclusionDiabetes makes a substantial contribution to the burden of incident tuberculosis in India, and the association is particularly strong for the infectious form of tuberculosis. The current diabetes epidemic may lead to a resurgence of tuberculosis in endemic regions, especially in urban areas. This potentially carries a risk of global spread with serious implications for tuberculosis control and the achievement of the United Nations Millennium Development Goals.
Author(s): Stevenson CR, Forouhi NG, Roglic G, Williams BG, Lauer JA, Dye C, Unwin NC
Publication type: Article
Publication status: Published
Journal: BMC Public Health
Year: 2007
Volume: 7
Issue: 1
Pages: 234
Date deposited: 29/06/2010
ISSN (electronic): 1471-2458
Publisher: BioMed Central Ltd.
URL: http://dx.doi.org/10.1186/1471-2458-7-234
DOI: 10.1186/1471-2458-7-234
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