Association between diabetes mellitus and cause of death in patients with tuberculosis: A Korean nationwide cohort study

PLoS One. 2023 Dec 14;18(12):e0295556. doi: 10.1371/journal.pone.0295556. eCollection 2023.

Abstract

Despite its significant impact on mortality, tuberculosis (TB)-diabetes mellitus (DM) co-prevalence has not been well-elucidated for the cause of death. We investigated the impact of DM on TB-related and non-TB-related deaths in patients with TB. This retrospective nationwide cohort study included patients diagnosed with TB between 2011 and 2017 in South Korea. We performed Fine and Gray regression model analyses to assess the mortality risk of DM classified by cause of death. Of 239,848 patients, 62,435 (26.0%) had DM, and 20,203 died during anti-TB treatment. Of all deaths, 47.9% (9,668) were caused by TB, and the remaining 52.1% (10,535) was attributed to various non-TB-related causes. The mortality rate was higher in the DM than in the non-DM groups in both men and women. DM was associated with a higher risk of TB-related (adjusted hazard ratio [aHR] 1.07, 95% confidence interval [CI] 1.01-1.13) and non-TB-related (aHR 1.21, 95% CI 1.15-1.27) deaths in men; however, only a higher risk of non-TB-related deaths (aHR 1.29, 95% CI 1.20-1.38) in women. Our findings indicate that DM is independently associated with a greater risk of death during anti-TB treatment among patients with TB for both TB-related and non-TB-related deaths.

MeSH terms

  • Cause of Death
  • Cohort Studies
  • Diabetes Mellitus*
  • Female
  • Humans
  • Male
  • Retrospective Studies
  • Risk Factors
  • Tuberculosis* / diagnosis

Grants and funding

This study was financially supported by the National Evidence-based Healthcare Collaborating Agency, funded by the Ministry of Health and Welfare (grant no. NC19-002, NC20- 003, and NC21-001), a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HI19C1235, HI22C0177), and by an intramural research grant from the Korean National Tuberculosis Association. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.