Impact of Diabetes and Smoking on Mortality in Tuberculosis

George W. Reed, Hongjo Choi, So Young Lee, Myungsun Lee, Youngran Kim, Hyemi Park, Jongseok Lee, Xin Zhan, Hyeungseok Kang, Soo Hee Hwang, Matthew Carroll, Ying Cai, Sang Nae Cho, Clifton E. Barry, Laura E. Via, Hardy Kornfeld

Research output: Contribution to journalArticle

56 Citations (Scopus)

Abstract

Background: Diabetes mellitus is a risk factor for tuberculosis (TB) disease. There is evidence that diabetes also influences TB severity and treatment outcomes but information is incomplete and some published results have been inconsistent. Methods: A longitudinal cohort study was conducted at the National Masan Tuberculosis Hospital in the Republic of Korea. Subjects presenting with a first episode of TB or for retreatment of TB were followed from enrollment through completion of treatment. Demographic, clinical, and microbiological variables were recorded, along with assessment of outcomes. Results were compared in TB patients with and without diabetes or smoking history. Data were adjusted for gender, age, cohort, educational level and alcohol consumption. Results: The combined cohorts comprised 657 subjects. Diabetes was present in 25% and was associated with greater radiographic severity and with recurrent or relapsed TB. Diabetes and cigarette smoking independently increased the risk of death in the first 12 months after enrollment. Estimating the combined impact of diabetes and smoking yielded a hazard ratio of 5.78. Only 20% of diabetic subjects were non-smokers; 54% smoked ≥1 pack daily. In this cohort, the impact of diabetes on mortality was greater in patients younger than 50 years, compared to older patients. Conclusions: In this cohort of Korean patients, diabetes exacerbated the severity of TB disease. Diabetic subjects who smoked ≥1 pack of cigarettes daily were at particularly high risk of death from TB. Strategies to improve TB outcomes could productively focus resources for patient education and TB prevention on the vulnerable population of younger diabetics, particularly those who also smoke.

Original languageEnglish
Article numbere58044
JournalPloS one
Volume8
Issue number2
DOIs
Publication statusPublished - 2013 Feb 28

Fingerprint

Medical problems
tuberculosis
diabetes
Tuberculosis
Smoking
Mortality
Tobacco Products
Chronic Disease Hospitals
patient education
death
Republic of Korea
Smoke
Retreatment
Vulnerable Populations
smoking (habit)
Patient Education
cigarettes
Hazards
educational status
South Korea

All Science Journal Classification (ASJC) codes

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)
  • General

Cite this

Reed, G. W., Choi, H., Lee, S. Y., Lee, M., Kim, Y., Park, H., ... Kornfeld, H. (2013). Impact of Diabetes and Smoking on Mortality in Tuberculosis. PloS one, 8(2), [e58044]. https://doi.org/10.1371/journal.pone.0058044
Reed, George W. ; Choi, Hongjo ; Lee, So Young ; Lee, Myungsun ; Kim, Youngran ; Park, Hyemi ; Lee, Jongseok ; Zhan, Xin ; Kang, Hyeungseok ; Hwang, Soo Hee ; Carroll, Matthew ; Cai, Ying ; Cho, Sang Nae ; Barry, Clifton E. ; Via, Laura E. ; Kornfeld, Hardy. / Impact of Diabetes and Smoking on Mortality in Tuberculosis. In: PloS one. 2013 ; Vol. 8, No. 2.
@article{4aaa1d3762a8427b8960fa1a90df3373,
title = "Impact of Diabetes and Smoking on Mortality in Tuberculosis",
abstract = "Background: Diabetes mellitus is a risk factor for tuberculosis (TB) disease. There is evidence that diabetes also influences TB severity and treatment outcomes but information is incomplete and some published results have been inconsistent. Methods: A longitudinal cohort study was conducted at the National Masan Tuberculosis Hospital in the Republic of Korea. Subjects presenting with a first episode of TB or for retreatment of TB were followed from enrollment through completion of treatment. Demographic, clinical, and microbiological variables were recorded, along with assessment of outcomes. Results were compared in TB patients with and without diabetes or smoking history. Data were adjusted for gender, age, cohort, educational level and alcohol consumption. Results: The combined cohorts comprised 657 subjects. Diabetes was present in 25{\%} and was associated with greater radiographic severity and with recurrent or relapsed TB. Diabetes and cigarette smoking independently increased the risk of death in the first 12 months after enrollment. Estimating the combined impact of diabetes and smoking yielded a hazard ratio of 5.78. Only 20{\%} of diabetic subjects were non-smokers; 54{\%} smoked ≥1 pack daily. In this cohort, the impact of diabetes on mortality was greater in patients younger than 50 years, compared to older patients. Conclusions: In this cohort of Korean patients, diabetes exacerbated the severity of TB disease. Diabetic subjects who smoked ≥1 pack of cigarettes daily were at particularly high risk of death from TB. Strategies to improve TB outcomes could productively focus resources for patient education and TB prevention on the vulnerable population of younger diabetics, particularly those who also smoke.",
author = "Reed, {George W.} and Hongjo Choi and Lee, {So Young} and Myungsun Lee and Youngran Kim and Hyemi Park and Jongseok Lee and Xin Zhan and Hyeungseok Kang and Hwang, {Soo Hee} and Matthew Carroll and Ying Cai and Cho, {Sang Nae} and Barry, {Clifton E.} and Via, {Laura E.} and Hardy Kornfeld",
year = "2013",
month = "2",
day = "28",
doi = "10.1371/journal.pone.0058044",
language = "English",
volume = "8",
journal = "PLoS One",
issn = "1932-6203",
publisher = "Public Library of Science",
number = "2",

}

Reed, GW, Choi, H, Lee, SY, Lee, M, Kim, Y, Park, H, Lee, J, Zhan, X, Kang, H, Hwang, SH, Carroll, M, Cai, Y, Cho, SN, Barry, CE, Via, LE & Kornfeld, H 2013, 'Impact of Diabetes and Smoking on Mortality in Tuberculosis', PloS one, vol. 8, no. 2, e58044. https://doi.org/10.1371/journal.pone.0058044

Impact of Diabetes and Smoking on Mortality in Tuberculosis. / Reed, George W.; Choi, Hongjo; Lee, So Young; Lee, Myungsun; Kim, Youngran; Park, Hyemi; Lee, Jongseok; Zhan, Xin; Kang, Hyeungseok; Hwang, Soo Hee; Carroll, Matthew; Cai, Ying; Cho, Sang Nae; Barry, Clifton E.; Via, Laura E.; Kornfeld, Hardy.

In: PloS one, Vol. 8, No. 2, e58044, 28.02.2013.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Impact of Diabetes and Smoking on Mortality in Tuberculosis

AU - Reed, George W.

AU - Choi, Hongjo

AU - Lee, So Young

AU - Lee, Myungsun

AU - Kim, Youngran

AU - Park, Hyemi

AU - Lee, Jongseok

AU - Zhan, Xin

AU - Kang, Hyeungseok

AU - Hwang, Soo Hee

AU - Carroll, Matthew

AU - Cai, Ying

AU - Cho, Sang Nae

AU - Barry, Clifton E.

AU - Via, Laura E.

AU - Kornfeld, Hardy

PY - 2013/2/28

Y1 - 2013/2/28

N2 - Background: Diabetes mellitus is a risk factor for tuberculosis (TB) disease. There is evidence that diabetes also influences TB severity and treatment outcomes but information is incomplete and some published results have been inconsistent. Methods: A longitudinal cohort study was conducted at the National Masan Tuberculosis Hospital in the Republic of Korea. Subjects presenting with a first episode of TB or for retreatment of TB were followed from enrollment through completion of treatment. Demographic, clinical, and microbiological variables were recorded, along with assessment of outcomes. Results were compared in TB patients with and without diabetes or smoking history. Data were adjusted for gender, age, cohort, educational level and alcohol consumption. Results: The combined cohorts comprised 657 subjects. Diabetes was present in 25% and was associated with greater radiographic severity and with recurrent or relapsed TB. Diabetes and cigarette smoking independently increased the risk of death in the first 12 months after enrollment. Estimating the combined impact of diabetes and smoking yielded a hazard ratio of 5.78. Only 20% of diabetic subjects were non-smokers; 54% smoked ≥1 pack daily. In this cohort, the impact of diabetes on mortality was greater in patients younger than 50 years, compared to older patients. Conclusions: In this cohort of Korean patients, diabetes exacerbated the severity of TB disease. Diabetic subjects who smoked ≥1 pack of cigarettes daily were at particularly high risk of death from TB. Strategies to improve TB outcomes could productively focus resources for patient education and TB prevention on the vulnerable population of younger diabetics, particularly those who also smoke.

AB - Background: Diabetes mellitus is a risk factor for tuberculosis (TB) disease. There is evidence that diabetes also influences TB severity and treatment outcomes but information is incomplete and some published results have been inconsistent. Methods: A longitudinal cohort study was conducted at the National Masan Tuberculosis Hospital in the Republic of Korea. Subjects presenting with a first episode of TB or for retreatment of TB were followed from enrollment through completion of treatment. Demographic, clinical, and microbiological variables were recorded, along with assessment of outcomes. Results were compared in TB patients with and without diabetes or smoking history. Data were adjusted for gender, age, cohort, educational level and alcohol consumption. Results: The combined cohorts comprised 657 subjects. Diabetes was present in 25% and was associated with greater radiographic severity and with recurrent or relapsed TB. Diabetes and cigarette smoking independently increased the risk of death in the first 12 months after enrollment. Estimating the combined impact of diabetes and smoking yielded a hazard ratio of 5.78. Only 20% of diabetic subjects were non-smokers; 54% smoked ≥1 pack daily. In this cohort, the impact of diabetes on mortality was greater in patients younger than 50 years, compared to older patients. Conclusions: In this cohort of Korean patients, diabetes exacerbated the severity of TB disease. Diabetic subjects who smoked ≥1 pack of cigarettes daily were at particularly high risk of death from TB. Strategies to improve TB outcomes could productively focus resources for patient education and TB prevention on the vulnerable population of younger diabetics, particularly those who also smoke.

UR - http://www.scopus.com/inward/record.url?scp=84874561615&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84874561615&partnerID=8YFLogxK

U2 - 10.1371/journal.pone.0058044

DO - 10.1371/journal.pone.0058044

M3 - Article

C2 - 23469139

AN - SCOPUS:84874561615

VL - 8

JO - PLoS One

JF - PLoS One

SN - 1932-6203

IS - 2

M1 - e58044

ER -

Reed GW, Choi H, Lee SY, Lee M, Kim Y, Park H et al. Impact of Diabetes and Smoking on Mortality in Tuberculosis. PloS one. 2013 Feb 28;8(2). e58044. https://doi.org/10.1371/journal.pone.0058044