Post-TB incidence of diabetes, myocardial infarction, and stroke

Salindri, A.D., Wang, J.Y., Lin, H.H. and Magee, M.J., 2019. Post-tuberculosis incidence of diabetes, myocardial infarction, and stroke: retrospective cohort analysis of patients formerly treated for tuberculosis in Taiwan, 2002–2013. International Journal of Infectious Diseases, 84, pp.127-130.
https://doi.org/10.1016/j.ijid.2019.05.015

Methods

A cohort study using data from the Taiwan National Health Insurance Research Database (NHIRD) during 2002–2013. The NHIRD, maintained by the National Health Research Institute, includes original registration and insurance claim data from the national health insurance system covering 99.9% of the Taiwanese population.

Include patients formerly treated for non-pediatric active TB disease. Apply age criteria: ≥15 years old for the diabetes mellitus (DM) study and ≥25 years old for the acute myocardial infarction (AMI) and stroke studies.

Confirm TB disease using ICD-9 codes (010-018) and prescriptions of anti-TB drugs for ≥28 days within a year. Define the earliest date of TB diagnosis indicated by ICD-9 codes as the TB date.

Exclude patients with ICD-9 diagnoses of diabetes, AMI, or stroke on or before the TB disease date.

Define incident non-communicable diseases (NCDs) as follows:
Diabetes: Patients who received anti-diabetes drug prescriptions for ≥28 days within a year and a confirmed diabetes ICD-9 code (250.X0 or 250.X2) first indicated ≥2 years after the TB date.
AMI: Defined by ICD-9 code 410.XX and ≥3 outpatient clinic visits or 1 hospitalization indicated ≥1 year after the TB date.
Stroke: Defined by ICD-9 codes 430.XX - 438.XX and ≥3 outpatient clinic visits or 1 hospitalization indicated ≥1 year after the TB date.

Collect data on other comorbidities, including dyslipidemia, hypertension, overweight, HIV, and chronic kidney diseases (CKD), using ICD-9 codes.

Calculate the incidence of diabetes, AMI, and stroke using Poisson regression. Use proportional hazards regression to estimate the relative hazards of NCDs incidence. Present incidence rates (IR) per 1000 person-years.

Censor patients if they left the insurance system or did not develop diabetes, AMI, or stroke by the end of the follow-up period (December 2013).

Findings

Older age, male gender, and traditional pre-existing chronic NCDs are predictive of diabetes, AMI, and stroke incidence post-TB treatment. Although the overall duration of TB treatment was not predictive of these NCD incidences, we found that patients treated for 7–12 months had a higher incidence of NCDs compared to those treated for ≤6 months. 

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