Tuberculosis Infection Among People With Diabetes: United States Population Differences by Race/Ethnicity

Published:February 13, 2020DOI:


      Diabetes might confer a modestly increased risk of latent tuberculosis infection, which without treatment can progress to active tuberculosis disease. Three recent analyses of the National Health and Nutrition Examination Survey found a positive association between diabetes and a positive test for Mycobacterium tuberculosis infection. This study examines whether prevalence of a positive test still varies by diabetes status after stratifying by race/ethnicity.


      This cross-sectional analysis used the public-use National Health and Nutrition Examination Survey 2011–2012 data sets and was conducted in 2018–2019. Interview and examination results for 5,560 adult participants yielded estimates for 219 million U.S. adults in the 4 largest race/ethnicity groups. The weighted prevalence of positive tuberculin skin test or interferon-gamma release assay by diabetes status was ascertained in each group.


      Among white and black adults, diabetes was associated with no difference in positive skin test prevalence and little difference in positive interferon-gamma release assay prevalence. The positive assay prevalence difference was +14.5% (95% CI=2.3%, 26.7%) among Hispanic and +9.9% (95% CI=1.2%, 18.6%) among Asian adults, when comparing those with diabetes with those with neither diabetes nor prediabetes. Based on assay results, 23.6% (95% CI=14.0%, 36.9%) of Hispanic and 27.2% (95% CI=19.6%, 36.5%) of Asian adults with diabetes also had latent tuberculosis infection.


      Hispanic and Asian subpopulation results drove much of the previously reported positive association between diabetes and a positive test for M. tuberculosis infection. Hispanic and Asian adults with diabetes might particularly benefit from screening and treatment for latent tuberculosis infection.
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        • CDC
        Reported tuberculosis in the United States.
        CDC, Atlanta, GA2018
        • Banyai AL
        • Cadden AV
        Diabetes and tuberculosis.
        Arch Intern Med (Chic). 1944; 74: 445-456
        • Al-Rifai RH
        • Pearson F
        • Critchley JA
        • Abu-Raddad LJ
        Association between diabetes mellitus and active tuberculosis: a systematic review and meta-analysis.
        PLoS One. 2017; 12e0187967
        • Bibbins-Domingo K
        • Grossman DC
        • et al.
        • U.S. Preventive Services Task Force
        Screening for latent tuberculosis infection in adults: US Preventive Services Task Force recommendation statement.
        JAMA. 2016; 316: 962-969
        • Institute of Medicine
        Ending Neglect: the Elimination of Tuberculosis in the United States.
        National Academies Press, Washington, DC2000
        • Taylor Z
        • Nolan CM
        • Blumberg HM
        • American Thoracic Society
        • Centers for Disease Control and Prevention
        • Infectious Diseases Society of America
        Controlling tuberculosis in the United States: recommendations from the American Thoracic Society, CDC, and the Infectious Diseases Society of America.
        MMWR Recomm Rep. 2005; 54: 1-81
        • Sandul AL
        • Nwana N
        • Holcombe JM
        • et al.
        High rate of treatment completion in program settings with 12-dose weekly isoniazid and rifapentine for latent Mycobacterium tuberculosis infection.
        Clin Infect Dis. 2017; 65: 1085-1093
        • Borisov AS
        • Bamrah MS
        • Njie GJ
        • et al.
        Update of recommendations for use of once-weekly isoniazid-rifapentine regimen to treat latent Mycobacterium tuberculosis infection.
        MMWR Morb Mortal Wkly Rep. 2018; 67: 723-726
        • Tasillo A
        • Salomon JA
        • Trikalinos TA
        • Horsburgh Jr, CR
        • Marks SM
        • Linas BP
        Cost-effectiveness of testing and treatment for latent tuberculosis infection in residents born outside the United States with and without medical comorbidities in a simulation model.
        JAMA Intern Med. 2017; 177: 1755-1764
        • Njie GJ
        • Morris SB
        • Woodruff RY
        • Moro RN
        • Vernon AA
        • Borisov AS
        Isoniazid-rifapentine for latent tuberculosis infection: a systematic review and meta-analysis.
        Am J Prev Med. 2018; 55: 244-252
        • Lee MR
        • Huang YP
        • Kuo YT
        • et al.
        Diabetes mellitus and latent tuberculosis infection: a systematic review and metaanalysis.
        Clin Infect Dis. 2017; 64: 719-727
        • Jackson C
        • Southern J
        • Lalvani A
        • et al.
        Diabetes mellitus and latent tuberculosis infection: baseline analysis of a large UK cohort.
        Thorax. 2019; 74: 91-94
        • Miramontes R
        • Hill AN
        • Yelk Woodruff RS
        • et al.
        Tuberculosis infection in the United States: prevalence estimates from the National Health and Nutrition Examination Survey, 2011‒2012.
        PLoS One. 2015; 10e0140881
        • Martinez L
        • Zhu L
        • Castellanos ME
        • et al.
        Glycemic control and the prevalence of tuberculosis infection: a population-based observational study.
        Clin Infect Dis. 2017; 65: 2060-2068
        • Barron MM
        • Shaw KM
        • Bullard KM
        • Ali MK
        • Magee MJ
        Diabetes is associated with increased prevalence of latent tuberculosis infection: findings from the National Health and Nutrition Examination Survey, 2011–2012.
        Diabetes Res Clin Pract. 2018; 139: 366-379
      1. National Center for Health Statistics. National Health and Nutrition Examination Survey: Analytic Guidelines, 2011–2014 and 2015–2016. Published 2018. Accessed January 9, 2020.

        • Paulose-Ram R
        • Burt V
        • Broitman L
        • Ahluwalia N
        Overview of Asian American data collection, release, and analysis: National Health and Nutrition Examination Survey 2011–2018.
        Am J Public Health. 2017; 107: 916-921
        • Haddad MB
        • Lash TL
        • Hill AN
        • et al.
        Robustness of NHANES estimates of the US prevalence of a positive tuberculin skin test.
        Epidemiology. 2020; 31: 248-258
        • Stout JE
        • Wu Y
        • Ho CS
        • et al.
        Evaluating latent tuberculosis infection diagnostics using latent class analysis.
        Thorax. 2018; 73: 1062-1070