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Analysis of Clinical Characteristics and Influencing Factors of Patients with Tuberculosis Complicated by Diabetes in Bao'an District, Shenzhen from 2016 to 2024

This study analyzes tuberculosis data from Bao'an District, Shenzhen (2016–2024) to reveal a significant year-on-year increase in the prevalence of diabetes comorbidity among patients, identifying male gender, older age, local residency, and specific treatment outcomes as key risk factors that necessitate enhanced early detection and monitoring strategies.

Original authors: Yali Qu, Zhenyang Liu, Peipei Huang, Jinzhou Mei, Li'ai Peng, Fangxiang Hu, Fan Huang, Yunxia Wang

Published 2026-06-26

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CC BY 4.0

Original authors: Yali Qu, Zhenyang Liu, Peipei Huang, Jinzhou Mei, Li'ai Peng, Fangxiang Hu, Fan Huang, Yunxia Wang

Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). ✨ This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer

Imagine the city of Shenzhen's Bao'an District as a massive, bustling library. For eight years (2016–2024), the librarians (doctors and researchers) kept a detailed log of every person who came in with a specific respiratory infection called Tuberculosis (TB).

This study is like a deep dive into that logbook to answer a simple question: "How many of these TB patients also have high blood sugar (Diabetes), and who are they?"

Here is the story of what they found, explained simply:

1. The "Double Trouble" Connection

Think of TB and Diabetes as two unruly roommates who make each other's lives much harder.

TB is a germ that attacks the lungs.
Diabetes is a condition where the body struggles to manage sugar, which weakens the immune system's "security guards."
When they live together in the same body, the security guards are too tired to fight the germ, making the TB harder to cure and the symptoms worse.

2. The Main Discovery: A Rising Tide

The researchers looked at 10,284 TB patients.

The Starting Line (2016): Only about 1 out of every 100 TB patients also had diabetes.
The Finish Line (2024): That number jumped to 12 out of every 100.
The Trend: It wasn't a sudden spike; it was a steady, year-by-year climb. By 2024, the rate in this district had actually surpassed the global average. It's like watching a slow-rising flood that is now higher than the ocean level.

3. Who is Most Likely to Have "Double Trouble"?

The study used a "magnifying glass" (statistical analysis) to see who was most likely to have both conditions. They found that certain groups were like "magnets" for this combination:

Gender: Men were much more likely to have both than women.
Age: If you are 30 or older, your odds skyrocket. The older you get, the higher the risk.
Background: People of Han ethnicity and local residents (those who live there permanently) were more likely to have both compared to migrants or ethnic minorities.
The "Sick" vs. The "Healthy":
- Patients whose TB was confirmed by finding the germ in their sputum (spit) were more likely to have diabetes.
- Patients who had positive sputum tests even after two months of treatment (meaning the medicine wasn't working fast enough) were much more likely to have diabetes.
- Analogy: Think of the medicine as a fire extinguisher. If the fire (TB) is still smoking after two months, it often means the house (the body) has a structural issue (Diabetes) making it hard to put out.

4. The "Who" and "Why" (The Data)

The researchers ran a complex calculation (like a sophisticated recipe) to see which factors were the main ingredients causing this mix. They found that being Male, Han, Local, Over 30, and having positive germ tests were the strongest predictors.

Interestingly, they found that people who were Retired or worked in service jobs (like housekeeping) had higher rates, while students and young children had almost zero cases of this combination.

5. What the Authors Recommend

Based on these findings, the authors suggest a specific strategy for the future:

Don't wait for the cough: If a man over 30 comes in with TB symptoms, doctors should immediately check for diabetes.
Watch the "Two-Month Mark": If a patient is still testing positive for TB germs after two months of treatment, the doctors should suspect diabetes might be the reason the medicine isn't working fast enough.
Focus on specific groups: The study suggests paying extra attention to local men, older adults, and those with confirmed germs in their lungs.

The Bottom Line

The paper tells us that while the number of TB patients with diabetes in this district started lower than the world average, it is growing fast and has now become a major concern. The "Double Trouble" is becoming more common, especially among older men and those whose TB isn't clearing up quickly. The authors argue that to win the battle against TB, we must start checking for and managing diabetes much earlier in the process.

Technical Summary: Analysis of Clinical Characteristics and Influencing Factors of Patients with Tuberculosis Complicated by Diabetes in Bao'an District, Shenzhen (2016–2024)

Problem Statement

Pulmonary tuberculosis (PTB) and diabetes mellitus (DM) constitute a dual disease burden that exacerbates clinical complexity, worsens treatment outcomes, and hinders global tuberculosis control efforts. While the World Health Organization (WHO) estimates that approximately 15.3% of global tuberculosis patients have comorbid diabetes, the specific epidemiological trends and clinical characteristics of this comorbidity within specific Chinese administrative regions require granular analysis. This study addresses the need to understand the evolving prevalence and risk factors of PTB-DM in Bao'an District, Shenzhen, to inform targeted prevention and treatment strategies.

Methodology

The study employed a retrospective cross-sectional design utilizing data from the "China Disease Prevention and Control Information System" (specifically the "Monitoring and Reporting Management – General Case Management" module).

Study Population: All pulmonary tuberculosis patients registered in Bao'an District, Shenzhen, between 2016 and 2024.
Sample Size: From an initial 10,398 registered cases, 10,284 eligible patients were included after excluding 114 cases reclassified as non-tuberculosis diseases or non-tuberculous mycobacterial pulmonary disease.
Data Collection: Variables included sociodemographic characteristics (age, gender, ethnicity, household registration, occupation, migrant status), clinical features (pathogen typing, treatment history, comorbid diabetes), and treatment outcomes (access routes, sputum smear results at 2 months, final treatment status).
Definitions:
- PTB Diagnosis: Classified per WS288–2017 standards into pathogen-positive, pathogen-negative, or undetermined.
- Diabetes Diagnosis: Based on "China Diabetes Prevention and Treatment Guidelines (2024 Edition)" (Fasting glucose ≥7.0 mmol/L, 2-hour OGTT ≥11.1 mmol/L, or HbA1c ≥6.5%).
- Treatment Outcomes: Classified as successful (cure/completion) or adverse (failure, death, loss to follow-up).
Statistical Analysis: Data were analyzed using SPSS 26.0. Categorical variables were compared using the Chi-square ( $\chi^2$ ) test and $\chi^2$ trend tests. Univariate analysis was followed by binary logistic regression to identify independent influencing factors for the co-occurrence of diabetes.

Key Results

Prevalence Trends:
- The overall prevalence of diabetes comorbidity among tuberculosis patients in the study period was 6.43% (661/10,284).
- A significant year-by-year increasing trend was observed, rising from 1.16% in 2016 to 12.50% in 2024 ( $\chi^2$ trend = 196.389, $P < 0.001$ ).
- This upward trend was consistent across the floating population, the 30–59 age group (2016–2022), and the 60+ age group (2018–2024).
Demographic and Clinical Characteristics:
- Gender/Ethnicity: Males (8.30% vs. 3.04% in females) and Han ethnicity (6.65% vs. 2.82% in minorities) showed significantly higher comorbidity rates.
- Age: Prevalence increased sharply with age: <30 years (0.36%), 30–59 years (9.11%), and 60–94 years (16.55%).
- Population Type: Local residents had a higher prevalence (9.33%) compared to the migrant population (6.10%).
- Pathogen Status: Pathogen-positive patients had a higher comorbidity rate (8.20%) compared to pathogen-negative (2.86%) or tuberculous pleurisy cases (1.12%).
- Treatment Response: Patients with comorbid diabetes were more likely to have positive sputum smears at the end of 2 months (13.83% vs. 5.11% in non-diabetic) and higher rates of non-tuberculosis related deaths (18.00%).
Multivariate Logistic Regression (Influencing Factors):
Independent factors significantly associated with a higher likelihood of diabetes comorbidity included:
- Male gender: OR = 2.487 (95% CI: 2.004–3.087).
- Han ethnicity: OR = 1.831 (95% CI: 1.105–3.035).
- Local population status: OR = 1.314 (95% CI: 1.027–1.681).
- Pathogen status: Pathogen-positive (OR = 8.297), Pathogen-negative (OR = 3.397), and No pathogen result (OR = 4.889) were all associated with higher odds compared to the reference group.
- Treatment outcomes: Positive sputum at 2 months (OR = 2.022) and no sputum result at 2 months (OR = 1.743).
- Age: Patients aged 30–59 (OR = 21.102) and ≥60 (OR = 31.392) had drastically higher odds compared to those <30.

Significance and Claims

The authors claim that while the overall prevalence of PTB-DM in Bao'an District (6.43%) was initially lower than the international average (15.3%), the rapid annual increase has caused the 2024 prevalence (12.50%) to exceed both international averages and previous domestic multicenter data (12.4% in 2011).

The study concludes that the rising prevalence of diabetes among tuberculosis patients poses a significant challenge to tuberculosis control efforts and the achievement of the WHO's "end TB" strategy by 2035. The authors assert that specific subgroups—particularly males, Han ethnicity, local residents, patients aged ≥30, and those with specific pathogen or sputum test profiles—require prioritized early detection and monitoring of treatment efficacy. The paper emphasizes that current treatment regimens may be insufficient for PTB-DM patients, evidenced by higher rates of persistent sputum positivity, necessitating strengthened health education, adherence monitoring, and potential adjustments in management protocols.