Volume 74, Issue 4
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


The association between tuberculosis and underlying risk factors was evaluated in Texas patients hospitalized in the 15 counties along the Mexico border within the remaining non-border counties. A case control analysis of the hospital discharge dataset from the Texas Health Care Information Council was performed for the years 1999–2001. A discharge diagnosis of tuberculosis identified cases ( = 4,915). Deep venous thrombosis, pulmonary embolism, and acute appendicitis conditions identified controls ( = 70,808). Risk factors associated with tuberculosis were identified by logistic regression. Diabetes patients were almost twice as likely to have tuberculosis after adjusting by sex, age, and race/ethnicity. The association was strong for the population in the Texas border region, where there are higher incidence rates of tuberculosis (odds ratio [OR] = 1.82; 95% CI = 1.57–2.12) compared with non-border counties (OR = 1.51; 95% CI = 1.36–1.67).


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  1. Pablos-Mendez A, Blustein J, Knirsch CA, 1997. The role of diabetes mellitus in the higher prevalence of tuberculosis among hispanics. Am J Public Health 87 : 574–579.
  2. Rieder HL, Cauthen GM, Comstock GW, Snider DE Jr, 1989. Epidemiology of tuberculosis in the United States. Epidemiol Rev 11 : 79–98.
  3. Small PM, Fujiwara PI, 2001. Management of tuberculosis in the United States. N Engl J Med 345 : 189–200.
  4. Boucot KR, Cooper DA, Dillon ES, Meier P, Richardson R, 1952. Tuberculosis among diabetics: The Philadelphia survey. Am Rev Tuberc 65 (suppl ): 1–50.
  5. Oscarsson N, Silwer H, 1958. Incidence of pulmonary tuberculosis among diabetics. Acta Med Scand 160 (suppl 335): 23–48.
  6. Ponce-De-Leon A, Garcia-Garcia ML, Garcia-Sancho MC, Gomez-Perez FJ, Valdespino-Gomez JL, Olaiz-Fernandez G, Rojas R, Ferreyra-Reyes L, Cano-Arellano B, Bobadilla M, Small PM, Sifuentes-Osornio J, 2004. Tuberculosis and diabetes in southern Mexico. Diabetes Care 27 : 1584–1590.
  7. Texas Department of Health, 1999. Texas action plan to control and eliminate tuberculosis. Available at http://www.tdh.state.tx.us/tb/publications.htm. Accessed December 2, 2004.
  8. Texas Department of Health, 2001, Diabetes in Texas. A risk factor report—1996–1999 survey data. Available at http://www.tdh.state.tx.us/chs/brfss/Reports/Diabe_n.pdf. Accessed January 12, 2004.
  9. Texas Department of Health-TB Elimination Division, 2004. TB cases and rates for 14 Texas-Mexico border counties. Available at http://www.tdh.state.tx.us/tb/BorderStatsByCounty.htm. Accessed December 1, 2004.
  10. The Department of State Health Services, 2004. Tuberculosis cases for Texas counties, 1996–2003. Available at http://www.tdh.state.tx.us/tb/CasesByCounty.htm. Accessed December 3, 2004.
  11. National Center for HIV, STD, and TB Prevention and Division of Tuberculosis Elimination, 2002. Table 17. Tuberculosis cases and case rates per 100,000 population: states, 2002 and 2001. Available at http://www.cdc.gov/nchstp/tb/surv/surv2002/tables/T17.htm. Accessed December 1, 2004.
  12. Centers for Disease Control, 2002. Reported tuberculosis in the United States, 2002. Avialable at http://www.cdc.gov/nchstp/tb/surv/surv2002/PDF/total.pdf. Accessed December 1, 2004.
  13. Sistema Nacional de Información en Salud, 2002. Anuario estadístico 2002. Available at http://www.salud.gob.mx/apps/htdocs/estadisticas/publicaciones/publicaciones.htm. Accessed December 1, 2004.
  14. Centers for Disease Control, 2001. Preventing and controlling tuberculosis along the U.S.-Mexico border. MMWR 50 : RR1.
  15. Texas Health Care Information Council, 2002. Texas Hospital Inpatient Discharge Public Use Data File,1999–2001. Austin, TX: Texas Health Care Information Council.
  16. The Health and Health Service Systems of Texans on the Texas-Mexico Border: Public Policy Implications, 2002, Houston, TX: The University of Texas at Houston Health Science Center, and School of Public Health.
  17. International Classification of Diseases, 1994. Clinical Modification. Los Angeles, CA: Practice Management Information Corporation.
  18. U.S.Census Bureau, 2002. 2000 census of population and housing, summary file 3: technical documentation. Available at http://www.census.gov/prod/cen2000/doc/sf3.pdf. Accessed December 2, 2004.
  19. Kleinbaum DG, 1994. Logistic Regression. A Self Learning Text. New York: Springer Verlag.
  20. Mokdad AH, Ford ES, Bowman BA, Dietz WH, Vinicor F, Bales VS, Marks JS, 2003. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA 289 : 76–79.
  21. Centers for Disease Control, 1995. Screening for tuberculosis and tuberculosis infection in high-risk populations. Recommendations of the Advisory Council for the Elimination of Tuberculosis. MMWR 44 : 19–34.
  22. Centers for Disease Control, American Thoracic Society, 2000. Targeted tuberculin testing and treatment of latent tuberculosis infection. MMWR 49 : 1–51.
  23. Mohan V, 2004. Why are Indians more prone to diabetes? J Assoc Physicians India 52 : 468–474.
  24. Burlando G, Sanchez RA, Ramos FH, Mogensen CE, Zanchetti A, 2004. Latin American consensus on diabetes mellitus and hypertension. J Hypertens 22 : 2229–2241.
  25. Bacakoglu F, Basoglu OO, Cok G, Sayiner A, Ates M, 2001. Pulmonary tuberculosis in patients with diabetes mellitus. Respiration 68 : 595–600.
  26. Perez-Guzman C, Torres-Cruz A, Villarreal-Velarde H, Vargas MH, 2000. Progressive age-related changes in pulmonary tuberculosis images and the effect of diabetes. Am J Respir Crit Care Med 162 : 1738–1740.
  27. Oursler KK, Moore RD, Bishai WR, Harrington SM, Pope DS, Chaisson RE, 2002. Survival of patients with pulmonary tuberculosis: clinical and molecular epidemiologic factors. Clin Infect Dis. 34 : 752–759.
  28. Bashar M, Alcabes P, Rom WN, Condos R, 2001. Increased incidence of multidrug-resistant tuberculosis in diabetic patients on the Bellevue Chest Service, 1987 to 1997. Chest 120 : 1514–1519.
  29. Singla R, Khan N, 2003. Does diabetes predispose to the development of multidrug-resistant tuberculosis? Chest 123 : 308–309.
  30. Palmer CE, Jablon S, Edwards PQ, 1957. Tuberculosis morbidity of young men in relation to tuberculin sensitivity and body build. Am Rev Tubercul 76 : 517–539.
  31. Harries AD, Nkhoma WA, Thompson PJ, Nyangulu DS, Wirima JJ, 1988. Nutritional status in Malawian patients with pulmonary tuberculosis and response to chemotherapy. Eur J Clin Nutr 42 : 445–450.
  32. Romano PS, Mark DH, 1994. Bias in the coding of hospital discharge data and its implications for quality assessment. Med Care 32 : 81–90.
  33. McMahon MM, Bistrian BR, 1995. Host defenses and susceptibility to infection in patients with diabetes mellitus. Infect Dis Clin North Am 9 : 1–9.

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  • Received : 21 Mar 2005
  • Accepted : 05 Dec 2005

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