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Estimates of the impact of diabetes on the incidence of pulmonary tuberculosis in different ethnic groups in England
  1. Caron Walker1,
  2. Nigel Unwin2
  1. 1Newcastle Primary Care Trust, Newcastle upon Tyne, UK
  2. 2Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
  1. Correspondence to Professor Nigel Unwin, Institute of Health and Society, Newcastle University, Newcastle upon Tyne NE2 4HH, UK; n.c.unwin{at}


Background There is good evidence that diabetes is a risk factor for pulmonary tuberculosis. In England, the rates of both diabetes and tuberculosis vary markedly by ethnic group.

Objective To estimate the proportion of incident cases of pulmonary tuberculosis attributable to diabetes (population attributable fraction, PAF) for Asian, black and white men and women aged ≥15 years in England.

Methods An epidemiological model was constructed using data on the incidence of tuberculosis, the prevalence of diabetes, the population structure for 2005 and the age-specific relative risk of tuberculosis associated with diabetes from a large cohort study.

Results The estimated PAF of diabetes for pulmonary tuberculosis is highest for Asian men (19.6%, 95% CI 10.9% to 33.1%) and women (14.2%, 95% CI 7.1% to 26.5%). The PAF for all ages is similar in white and black men (6.9%, 95% CI 3.1% to 12.4% and 7.4%, 95% CI 4.6% to 12.9%, respectively) and women (8.2%, 95% CI 3.0% to 15.6% and 8.9%, 95% CI 5.3% to 15.6%, respectively). The similarity of these overall figures, despite a higher prevalence of diabetes in the black population, reflects a much younger mean age of pulmonary tuberculosis in the black population. Overall, of 3461 new cases of pulmonary tuberculosis in England in 2005, 384 (202–780) were estimated to be attributable to diabetes.

Conclusion Given the nature of the data available, considerable uncertainty surrounds these estimates. Nonetheless, they highlight the potential importance of diabetes as a risk factor for pulmonary tuberculosis, particularly in groups at high risk of both diseases. Further research to examine the implications of these findings for tuberculosis control is urgently needed.

  • Tuberculosis
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  • Funding No specific funding was needed for the work contained in this article. NU is funded by Newcastle University and CW by the North East Strategic Health Authority.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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