Diabetes, undernutrition, migration and indigenous communities: tuberculosis in Chiapas, Mexico

Abstract

We investigated the distribution of comorbidities among adult tuberculosis (TB) patients in Chiapas, the poorest Mexican state, with a high presence of indigenous population, and a corridor for migrants from Latin America. Secondary analysis on 5508 new adult TB patients diagnosed between 2010 and 2014 revealed that the most prevalent comorbidities were diabetes mellitus (DM; 19.1%) and undernutrition (14.4%). The prevalence of DM in these TB patients was significantly higher among middle aged (41–64 years) compared with older adults (⩾65 years) (38.6% vs. 23.2%; P < 0.0001). The prevalence of undernutrition was lower among those with DM, and higher in communities with high indigenous presence. Immigrants only comprised 2% of all TB cases, but were more likely to have unfavourable TB treatment outcomes (treatment failure, death and default) when compared with those born in Chiapas (29.5% vs. 11.1%; P < 0.05). Unfavourable TB outcomes were also more prevalent among the TB patients with undernutrition, HIV or older age, but not DM (P < 0.05). Our study in Chiapas illustrates the challenges of other regions worldwide where social (e.g. indigenous origin, poverty, migration) and host factors (DM, undernutrition, HIV, older age) are associated with TB. Further understanding of these critical factors will guide local policy makers and health providers to improve TB management.

Current State of Diabetes Mellitus Prevalence, Awareness, Treatment, and Control in Latin America: Challenges and Innovative Solutions to Improve Health Outcomes Across the Continent

“…infectious diseases, like tuberculosis [303][304][305]. Therefore, disease prevention and health care models that account and reach these populations need to be considered.…”

“…Understanding the protective mechanisms (e.g., biochemical, immune, epigenetic) against diabetes experienced by some indigenous populations would be relevant to millions at high risk of developing diabetes. At the same time, the increased prevalence of the metabolic syndrome and diabetes experienced by some indigenous groups and other ethnic groups may increase their risk not only for CVD and other diabetes long-term complications but also for re-emerging infectious diseases, like tuberculosis [ 303 – 305 ]. Therefore, disease prevention and health care models that account and reach these populations need to be considered.…”

Asociación del estado nutricional y factores clínicos con muerte relacionada con tuberculosis en Colombia

“…En pacientes hospitalizados 17 y no hospitalizados 18 de Brasil, la prevalencia de desnutrición fue de 36,1 y 50%, respectivamente. En México, los reportes de desnutrición en este tipo de pacientes varían desde 56,8 19 a 14,4% 11 . La prevalencia de desnutrición en población de Taiwán de 27% 20 y de 14,4% en Nepal 21 son las más similares a las encontradas en este estudio.…”

“…Diferentes estudios relacionan la mortalidad por TBC con características socio-demográficas de los pacientes (edad, sexo, pertenencia étnica, entre otras) y la presencia de co-morbilidades [11][12][13][14] . Sería importante saber si en Colombia, independientemente de las variables que tradicionalmente se asocian con muerte, se puede establecer al mismo tiempo una asociación con los casos de desnutrición, a fin de facilitar la formulación de estrategias ajustadas que permitan la consecución de las metas del programa.…”

Amerindian genetic ancestry as a risk factor for tuberculosis in an amazonian population

“…Tuberculosis (TB) is an infectious disease caused by the Mycobacterium tuberculosis bacillus (MTB). In 2018, 10 million incident cases of TB were registered, resulting in 1.2 million TB deaths, a number higher than that caused by Human Immunodeficiency Virus [1,2]. While the incidence of TB and the total number of deaths, worldwide, have declined slightly in recent years, TB continues to be a major endemic concern for the amerindian people of the Brazilian Amazon [3,4].…”