[학위논문]건강보험 빅데이터를 이용한 제2형 당뇨병환자의 결핵발생률과 관련요인 Incidence and affecting factors for tuberculosis among patients with type 2 diabetes mellitus using health insurance big data원문보기
Objectives: Diabetes mellitus(DM) is known as a risk factor for tuberculosis(TB). Soaring prevalence of DM globally would have a negative impact on TB control strategy is predicted. The present study evaluated the incidence rate of TB and affecting factors on TB from patients with type 2 Diabetes Me...
Objectives: Diabetes mellitus(DM) is known as a risk factor for tuberculosis(TB). Soaring prevalence of DM globally would have a negative impact on TB control strategy is predicted. The present study evaluated the incidence rate of TB and affecting factors on TB from patients with type 2 Diabetes Mellitus(T2DM) in Korea. Methods: We used customized big data provided by the National Health Insurance sharing service to conduct a retrospective cohort study. Type 2 diabetic cohort and Non-diabetic cohort comprised 428,858 and 486,673 subjects aged 45-64, respectively. Baseline data was evaluated with national health examination and medical use database between 2010 and 2011. The incidence of TB was calculated through follow-up from Jan 2012 to Dec 2017. Cox's proportional hazard model was used to identify affecting factors on TB. Results: Mean annual incidence of TB was 76.5 in type 2 diabetic cohort and 41.4 in non-diabetic cohort per 100,000 person-year each. Type 2 diabetic cohort's hazard ratio(HR) was 1.85(95% CI 1.80-1.91), 1.94(95% CI 1.86-2.02) among men, 1.67(95% CI 1.59-1.74) among women compared with non-diabetic cohort. Age, middle and low income, body mass index(BMI)<18.5 kg/m2, number of chronic complications of T2DM, current smoking and inactive were risk factors of TB in men. Otherwise, BMI≥25 kg/m2 and sociable drinking showed a preventive effect. Age, underweight, chronic complications of T2DM, smoking, inactive were risk factors of TB in women. On the other, first-stage obesity(BMI 25-29.9 kg/m2) and sociable drinking showed prevention effect. Regardless of gender, underweight was a strong risk factor. As age or the number of T2DM chronic complications increases on, the hazard ratio(HR) of TB became higher. Increasing BMI showed a preventive effect against tuberculosis, but the effect disappeared in women with second-stage obesity and two or more chronic complications of T2DM. Conclusions: The risk of tuberculosis in the T2DM cohort was higher than that of the non-diabetic cohort. Increasing age, low BMI and growing the number of chronic complication of T2DM were risk factors for TB in the elderly. Preventing diabetes, diabetic complications and underweight could help to prevent TB. Also, regular physical activity and smoking cessation are needed.
Objectives: Diabetes mellitus(DM) is known as a risk factor for tuberculosis(TB). Soaring prevalence of DM globally would have a negative impact on TB control strategy is predicted. The present study evaluated the incidence rate of TB and affecting factors on TB from patients with type 2 Diabetes Mellitus(T2DM) in Korea. Methods: We used customized big data provided by the National Health Insurance sharing service to conduct a retrospective cohort study. Type 2 diabetic cohort and Non-diabetic cohort comprised 428,858 and 486,673 subjects aged 45-64, respectively. Baseline data was evaluated with national health examination and medical use database between 2010 and 2011. The incidence of TB was calculated through follow-up from Jan 2012 to Dec 2017. Cox's proportional hazard model was used to identify affecting factors on TB. Results: Mean annual incidence of TB was 76.5 in type 2 diabetic cohort and 41.4 in non-diabetic cohort per 100,000 person-year each. Type 2 diabetic cohort's hazard ratio(HR) was 1.85(95% CI 1.80-1.91), 1.94(95% CI 1.86-2.02) among men, 1.67(95% CI 1.59-1.74) among women compared with non-diabetic cohort. Age, middle and low income, body mass index(BMI)<18.5 kg/m2, number of chronic complications of T2DM, current smoking and inactive were risk factors of TB in men. Otherwise, BMI≥25 kg/m2 and sociable drinking showed a preventive effect. Age, underweight, chronic complications of T2DM, smoking, inactive were risk factors of TB in women. On the other, first-stage obesity(BMI 25-29.9 kg/m2) and sociable drinking showed prevention effect. Regardless of gender, underweight was a strong risk factor. As age or the number of T2DM chronic complications increases on, the hazard ratio(HR) of TB became higher. Increasing BMI showed a preventive effect against tuberculosis, but the effect disappeared in women with second-stage obesity and two or more chronic complications of T2DM. Conclusions: The risk of tuberculosis in the T2DM cohort was higher than that of the non-diabetic cohort. Increasing age, low BMI and growing the number of chronic complication of T2DM were risk factors for TB in the elderly. Preventing diabetes, diabetic complications and underweight could help to prevent TB. Also, regular physical activity and smoking cessation are needed.
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