Diabetes and prevalence of latent tuberculosis by metformin and statin use, NHANES adult participants 2011–2012
| Diabetes status | QuantiFERON-TB Gold In-Tube (QFT) | Tuberculin skin test (TST) | |||||
| QFT positive# % (95% CI) | Prevalence difference¶ % (95% CI) | OR (95% CI) | TST positive# % (95% CI) | Prevalence difference¶ % (95% CI) | OR (95% CI) | ||
| All NHANES | Diabetes | 11.6 (7.9–15.3) | 7.0 (3.1–10.8)+ | 2.7 (1.8–4.1)§ | 7.1 (4.8–9.3) | 3.0 (0.6–5.4)+ | 1.8 (1.2–2.8)§ |
| Pre-diabetes | 7.0 (5.2–8.7) | 2.3 (1.0–3.7)+ | 1.5 (1.2–1.9)§ | 6.5 (2.6–10.4) | 2.4 (0.8–5.6)+ | 1.6 (1.0–2.7) | |
| Euglycaemic | 4.6 (3.7–5.6) | Ref. | Ref. | 4.1 (2.6–5.6) | Ref. | Ref. | |
| Subgroups | |||||||
| No metformin | Diabetesf | 12.3 (8.0–16.6) | 1.4 (−3.7–6.4) | 1.1 (0.7–1.9) | 8.4 (5.6–11.2) | 2.7 (−0.3–5.7) | 1.5 (1.0–2.5) |
| Any metformin use | 10.9 (6.0–15.8) | Ref. | Ref. | 5.7 (3.1–8.3) | Ref. | Ref. | |
| No agent | Diabetesf | 12.5 (7.5–17.5) | 6.3 (−4.4–17.0) | 2.2 (0.4–10.5) | 10.7 (6.2–15.3) | 8.9 (4.4–13.4)+ | 6.5 (2.3–18.1)§ |
| Non-metformin | 11.7 (7.3–16.0) | 5.4 (−4.6–15.5) | 2.0 (0.4–9.2) | 4.7 (1.9–7.6) | 2.9 (−0.4–6.2) | 2.7 (0.9–8.2) | |
| Metformin only | 13.1 (4.8–21.3) | 6.8 (−6.0–19.6) | 2.3 (0.4–12.3) | 8.4 (4.7–12.2) | 6.6 (2.5–10.7)+ | 4.9 (1.6–14.9)§ | |
| Metformin+1## | 11.4 (4.6–18.2) | 5.2 (−4.8–15.2) | 1.9 (0.4–9.6) | 5.4 (1.3–9.4) | 3.6 (−0.5–7.6) | 3.1 (1.0–9.3)§ | |
| Metformin+ ≥2## | 6.2 (0.0–15.8) | Ref. | Ref. | 1.8 (0.0–3.8) | Ref. | Ref. | |
| No metformin/statin | Diabetesf | 12.6 (6.4–18.8) | 2.1 (−4.4–8.6) | 1.2 (0.7–2.3) | 9.6 (5.1–14.2) | 5.6 (0.4–10.9)+ | 2.6 (1.1–5.9)§ |
| Statin | 11.8 (7.2–16.4) | 1.4 (−6.5–9.2) | 1.1 (0.5–2.6) | 6.1 (2.5–9.6) | 2.1 (−2.9–7.0) | 1.6 (0.6–4.4) | |
| Metformin | 11.6 (3.8–19.5) | 1.2 (−8.3–10.7) | 1.1 (0.4–3.0) | 8.0 (3.0–13.1) | 4.0 (−1.5–9.5) | 2.1 (0.8–5.2) | |
| Statin+metformin | 10.4 (4.6–16.3) | Ref. | Ref. | 4.0 (1.6–6.4) | Ref. | Ref. | |
| No statin use | Diabetesf | 12.1 (6.9–17.3) | 9.1 (2.8–15.3)+ | 4.4 (1.3–14.9)§ | 8.9 (4.9–13.0) | 6.1 (−0.3–12.4) | 3.3 (0.6–18.3) |
| Simvastatin | 12.7 (6.4–19.1) | 9.7 (1.3–18.1)+ | 4.7 (1.1–19.7)§ | 4.2 (0.9–7.5) | 1.3 (−5.6–8.2) | 1.5 (0.2–11.5) | |
| Atorvastatin | 12.8 (5.6–20.1) | 9.8 (2.1–17.5)+ | 4.7 (1.4–16.0)§ | 4.4 (0.5–8.3) | 1.5 (−4.9–8.0) | 1.6 (0.2–10.2) | |
| Other statins | 9.7 (2.8–16.5) | 6.7 (−1.3–14.7) | 3.4 (0.8–14.0) | 7.9 (3.1–12.8) | 5.1 (−2.6–12.8) | 2.9 (0.4–19.4) | |
| Pravastatin | 3.0 (0.0–6.7) | Ref. | Ref. | 2.9 (0.0–7.9) | Ref. | Ref. | |
| Any statin use¶¶ | Diabetes | 11.0 (7.3–14.8) | 6.5 (2.0–11.1)+ | 2.6 (1.4–5.1)§ | 4.8 (3.1–6.5) | 1.2 (−2.3–4.7) | 1.3 (0.5–3.4) |
| Pre-diabetes | 5.4 (2.3–8.5) | 0.9 (−1.5–3.3) | 1.2 (0.8–2.0) | 5.0 (0.0–10.1) | 1.3 (−4.0–6.7) | 1.4 (0.4–4.7) | |
| Euglycaemic | 4.5 (2.4–6.6) | Ref. | Ref. | 3.7 (0.8–6.5) | Ref. | Ref. | |
| No statin use | Diabetes | 12.2 (6.8–17.6) | 7.6 (2.2–13.0)+ | 2.9 (1.7–4.8)§ | 9.0 (4.8–13.3) | 4.9 (0.8–9.0)+ | 2.3 (1.3–3.9)§ |
| Pre-diabetes | 7.5 (5.5–9.5) | 2.8 (0.9–4.8)+ | 1.7 (1.2–2.2)§ | 7.1 (2.6–11.5) | 2.9 (−0.9–6.7) | 1.7 (1.0–3.0)§ | |
| Euglycaemic | 4.7 (3.7–5.6) | Ref. | Ref. | 4.2 (2.8–5.6) | Ref. | Ref. | |
NHANES: National Health and Nutrition Examination Survey. #: among NHANES 2011–2012 adult participants, n=4958 had valid diabetes and QFT results, n=4261 had valid diabetes and TST results (TST positive defined by induration ≥10 mm); ¶: Taylor series variance estimation for 95% CI of prevalence difference; +: Rao–Scott Chi-squared p-value <0.05; §: Wald Chi-squared p-value <0.05; f: among participants with diabetes and with QFT results (n=791) or TST results (n=685) available; ##: metformin in combination with any one or two other diabetes medications; ¶¶: Wald Chi-squared test for interaction p-value <0.03 between diabetes status and statin use with latent tuberculosis infection measured by TST.