The Role of Tuberculosis Disease on Non-Communicable Disease Risk: Comparative Analysis of Large Healthcare Databases

结核病对非传染性疾病风险的作用：大型医疗数据库的比较分析

• 批准号: 10308522
• 负责人: Julia Alison Critchley
• 金额: $ 13.23万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-12-01 至 2023-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10308522
• 关键词: Address; Adipose tissue; Age; Aging; Animal Model; Asthma; Bacteriology; Body mass index; Cardiovascular Diseases; Caring; Cessation of life; Characteristics; Chronic; Chronic Obstructive Pulmonary Disease; Chronic stress; Clinical; Clinical Data; Code; Communicable Diseases; Complementary Health; Comprehensive Health Care; Control Groups; Coronary Arteriosclerosis; Country; Data; Data Analyses; Data Set; Databases; Development; Diabetes Mellitus; Diagnosis; Diagnostic; Disease; Disease Outcome; Drug Prescriptions; Electronic Health Record; Ensure; Epidemic; Ethnic Origin; Etiology; Future; Glucose; Goals; HIV; Health Services; Healthcare; Homeostasis; Hospital Mortality; Hospitalization; Impairment; Incidence; Income; Inflammation; Inflammatory; Insulin Resistance; International Classification of Disease Codes; Intervention Studies; Ischemic Stroke; Knowledge; Lead; Link; Lipids; Lung; Lung diseases; Mediating; Mediator of activation protein; Medical; Migrant; Morbidity - disease rate; Nature; Non-Insulin-Dependent Diabetes Mellitus; Obesity; Outcome; Participant; Patient Care; Patients; Peripheral Vascular Diseases; Persons; Population; Prevention; Prevention approach; Primary Health Care; Protocols documentation; Public Health; Publications; Pulmonary Tuberculosis; Race; Recording of previous events; Reporting; Research; Risk; Role; Smoking Status; Socioeconomic Status; Survivors; Time; Transient Ischemic Attack; Tuberculosis; United Kingdom; United States Department of Veterans Affairs; Validation; Veterans; Vital Status; Work; antimicrobial; attributable mortality; base; biological sex; clinical practice; cohort; comparative; design; diabetes risk; disability; disorder control; disorder risk; ethnic minority population; experience; follow-up; high risk; improved; knowledge base; large datasets; low and middle-income countries; low income country; lung injury; mortality; multiple chronic conditions; pathogen; patient population; prevent; prospective; research study; respiratory; sex; tuberculosis treatment

PROJECT SUMMARY The intersection of tuberculosis (TB) disease with non-communicable diseases (NCDs), including diabetes mellitus, pulmonary disease, and cardiovascular disease, has emerged as a critical public health concern. Rapidly expanding NCD epidemics threaten TB control in low- and middle-income countries, where preventing and treating TB disease remains a great burden. However, to date, the notion that TB disease may increase the risk of chronic NCDs has not been well explored. Using two large healthcare databases, we will determine the extent that TB increases the risk of post-TB diabetes, pulmonary disease, and cardiovascular disease. This secondary data analysis research study will advance understanding of dual burdens of TB and NCD multimorbidity and build a knowledge base for integrated care and prevention of NCDs. The overall objective of this study is to improve understanding of the relationship between TB disease and subsequent risks of diabetes, pulmonary disease, and cardiovascular disease, and to identify targets for preventing these NCDs among TB patients. The specific aims of this proposal are to: (1) determine the extent to which TB disease increases the risk of future development of diabetes mellitus, pulmonary disease (asthma and COPD) and cardiovascular disease (ischemic stroke, coronary artery disease, peripheral vascular disease, and transient ischemic attack TIA), (2) determine the extent to biologic sex, BMI, HIV, race/ethnicity, and age at time of TB disease modify and mediate the relationships between TB and incidence of diabetes, pulmonary disease, and CVD, and (3) explore TB clinical characteristics that predict early NCD incidence (a first diagnosis of diabetes, pulmonary diseases, or CVD within 5 years after TB cure) among patients with previous TB disease. To meet the study’s objectives and aims, we will leverage two well-characterized and comprehensive health care databases. First, we will use electronic health records from the US Veterans Affairs Medical Care Centers to assemble comparable data on diagnostic codes, prescription medication use, hospitalization, and vital status. Second, we will use the Clinical Practice Research Datalink, a database of primary care patients in the United Kingdom that is nationally representative and linked to hospital admissions and mortality data. The proposed approach will allow us to assemble a cohort of >16,000 TB survivors and follow them for an average of 6.5 years. We will then compare NCD incidence among TB survivors to >64,000 age, sex, and race/ethnicity matched controls without previous TB. The proposed study will importantly characterize the extent to which TB contributes to post-TB NCD multimorbidity. The comparison of post-TB outcomes across two large health care will greatly strengthen the validity of our results and increase the ability to suggest causal inferences based on our findings. A long-term goal of the proposed work is to prepare for prospective interventional studies that evaluate NCD prevention approaches during TB treatment and determine their efficacy several years after TB treatment.

项目摘要 结核病（TB）疾病与非通信疾病（NCD）的交集，包括糖尿病， 肺部疾病和心血管疾病已成为关键的公共卫生问题。迅速 扩大NCD情节威胁着低收入和中等收入国家的结核病控制 结核病仍然是一个很大的伯恩。但是，迄今为止，通知结核病可能会增加慢性病的风险 NCD尚未得到很好的探索。使用两个大型医疗保健数据库，我们将确定结核病的程度 增加了结核病后糖尿病，肺部疾病和心血管疾病的风险。此次要数据 分析研究将提高对结核病和NCD多发病双重燃烧的了解，并建立一个 NCD综合护理和预防的知识库。 这项研究的总体目的是提高对结核病与TB疾病之间关系的理解 随后的糖尿病，肺部疾病和心血管疾病的风险，并确定预防目标 TB患者中的这些NCD。该提案的具体目的是：（1）确定结核病的程度 疾病增加了糖尿病，肺部疾病（哮喘和COPD）的未来发展风险 心血管疾病（缺血性中风，冠状动脉疾病，周围血管疾病和瞬态 缺血性攻击TIA），（2）确定结核病时生物学性别，BMI，HIV，种族/种族和年龄的程度 疾病修改并调解结核病与糖尿病，肺部疾病和 CVD和（3）探索预测早期NCD发病率的结核病临床特征（糖尿病的第一个诊断， 在结核病治疗后5年内，肺部疾病或CVD患有先前结核病患者。见面 研究的目标和目标，我们将利用两个良好的且全面的医疗保健数据库。 首先，我们将使用美国退伍军人事务医疗中心的电子健康记录组装 关于诊断代码，处方药物使用，住院和生命状况的可比数据。第二，我们 将使用临床实践研究数据链接，这是英国初级保健患者的数据库 全国代表并与医院入院和死亡率数据有关。拟议的方法将允许 我们要组装> 16,000个结核动物的队列，并平均跟随它们6。5年。然后我们将比较 NCD在结核病生存中的事件> 64,000年龄，性别和种族/种族与没有以前的结核病相匹配。 拟议的研究将重要的是TB对结核病后NCD多发病的贡献的程度。 在两个大型医疗保健中的结核病后结果的比较将极大地增强我们结果的有效性 并提高根据我们的发现提出因果推断的能力。拟议工作的长期目标 是为预期的介入研究做准备，该研究在结核病治疗期间评估NCD预防方法 并确定结核病治疗几年后的效率。