INT J TUBERC LUNG DIS 21(7):804–809
Q 2017 The Union
http://dx.doi.org/10.5588/ijtld.17.0038
Depression and risk of tuberculosis: a nationwide population-
based cohort study
K. H. Oh,*† H. Choi,* E. J. Kim,† H. J. Kim,* S. I. Cho†
*Korean Institute of Tuberculosis, Cheongju, †Graduate School of Public Health, Seoul National University, Seoul,
Korea
B A C K G R O U N D : Studies on the association between
depression and risk of tuberculosis (TB) are lacking.
O B J E C T I V E : To determine the association between
depression and risk of TB.
M E T H O D S : From a nationwide database, patients with
depression were identified to form the exposure cohort
between 2003 and 2013. The control cohort comprised
an equivalent number of subjects without any mood
disorders, with each subject age- and sex-matched to a
patient in the exposure cohort. The incidence of TB was
identified in the exposure cohort and control cohort
between 2003 and 2013. A multivariable Cox propor-
TUBERCULOSIS (TB) is a major global health
problem. According to the World Health Organiza-
tion (WHO), an estimated 10.4 million incident cases
of TB and 1.8 million TB-related deaths occurred in
2015.1 TB ranks as a leading cause of death due to
infectious disease worldwide.
Various risk factors for TB, such as human
immunodeficiency virus (HIV) infection,2 undernu-
trition,3 diabetes mellitus (DM),4 smoking,5 alcohol
over-consumption,6 silicosis,7 a wide range of sys-
temic diseases, and the use of immunosuppressive
agents have been identified.8 Most of these risk
factors result in a weakened host immune system,
which increases the risk of TB. Mental disorders,
including depression and severe mental stress, have
been proposed as risk factors for TB as they have a
negative impact on cell-mediated immunity.9 How-
ever, to the best of our knowledge, the association
between depression or mental stress and the subse-
quent risk of TB has not been investigated.
The Global Burden of Disease report estimated that
neuropsychiatric disorders account for 13.5% of the
global disease burden, expressed as disability-adjust-
ed life years, which is higher than the contribution
made by cardiovascular disease or cancer among non-
Correspondence to: Kyung Hyun Oh, Programme Cooperation, Korean Institute of Tuberculosis, 168-5 Osongsaeng-
myeong4-ro, Osong-eup, Heungdeok-gu Cheongju-si Chungbuk 363-954, Republic of Korea. e-mail: kyunghyun.oh@
gmail.com
Article submitted 16 January 2017. Final version accepted 30 March 2017.
SUMMARY
tional hazards model was used to estimate the associa-
tion between depression and the subsequent risk of TB.
R E S U LT S : A total of 32 372 patients with depression
and the same number of controls were identified. The
risk of TB in the depression cohort was 2.63-fold
(95%CI 1.74–3.96) higher than in the control cohort.
When the depression was classified as ‘mild’ and
‘severe’, the risk of TB was proportional to depression
severity.
C O N C L U S I O N S : Patients with depression are at a
higher risk for TB, and a dose-response relationship
exists between depression and the subsequent risk of TB.
K E Y W O R D S : risk of TB; depression; cohort study
communicable diseases (NCDs).10 Among the vari-
ous neuropsychiatric disorders, depression was found
to be the single most burdensome disorder.10 If
depression is a risk factor for TB, the considerable
burden imposed by depression may act as a barrier to
global TB elimination.
The present study aimed to elucidate the associa-
tion between depression and the development of TB.
METHODS
Data source
This study used the Korean National Health Insur-
ance Service-National Sample Cohort (NHIS-NSC),
which sampled 1 million subjects with national
representativeness from among the entire population
covered by the NHIS in 2002.11 The database
contains individual-level data on socio-demographic
variables, mortality, health examinations, and use of
medical services, along with International Classifica-
tion of Disease, Tenth Revision (ICD-10) codes
between 2002 and 2013.11
The institutional review board of the Korea
National Institute for Bioethics Policy, Seoul, South
Korea, exempted this study from a full review as it

was a retrospective study using an encrypted database
(P01-201604-21-008).
Study sample
The study sample consisted of an exposure cohort and
a control cohort. Patients with a diagnosis of
depression or TB who used medical services in 2002
were excluded from the NHIS-NSC to rule out chronic
conditions of depression or TB. Patients with depres-
sion newly diagnosed between 2003 and 2013 were
selected from among the remaining subjects to
establish the exposure cohort. Patients diagnosed with
TB before the diagnosis of depression were excluded
from the exposure cohort. The control cohort com-
prised an equivalent number of individuals without
any mood disorders, with each individual age- and sex-
matched to a patient in the exposure cohort. The
incidence of TB was identified in the exposure cohort
and control cohort between 2003 and 2013.
Definition of depression
‘Depression’ was defined based on ICD-10 codes for
depression (F32.0–F32.3 and F33.0–F33.3), and the
prescription of psychotherapy was used to confirm
the validity of the diagnosis. Psychotherapy can be
prescribed only by psychiatrists in Korea, and all
psychiatrists prescribe psychotherapy each time they
see a patient under the fee-for-service system.
Furthermore, patients suffering from depression were
categorised into ‘mild’ and ‘severe’ subgroups. If
patients were registered under ICD-10 codes F32.1–
F32.3 or F33.1–F33.3 one or more times when using
medical services for depression, they were classified
as having severe depression. Other cases were
categorised as mild depression.
Definition of tuberculosis incidence
TB incidence was defined using a two-step process.
First, ICD-10 codes A15–A19 were used to include
patients diagnosed with TB. TB diagnosis was then
confirmed on the basis of prescription of an anti-
tuberculosis drug, which was defined as the prescription
of two or more anti-tuberculosis drugs for simultaneous
use for .30 days. The anti-tuberculosis drugs included
were isoniazid, rifampicin, ethambutol, pyrazinamide,
amikacin, kanamycin, streptomycin, quinolones, thio-
amide, cycloserine and para-aminosalicylic acid.
Co-variables
Individual income level and comorbidities that could
influence TB incidence were evaluated as independent
variables. The income level was scored on a scale of
0–10 in the NHIS-NSC. We categorised patients into
three groups on the basis of their income level score:
low (0–3), middle (4–6) and high (7–10). Comorbid-
ities were identified on the basis of ICD-10 codes:
DM (E10–E14), chronic obstructive pulmonary
disease (COPD) (J40–J44) and alcoholism (F10).
Depression and risk of TB 805
Statistical analysis
Proportional differences in independent variables
between the depression cohort and the control cohort
were analysed using the v2 test. Cumulative TB
incidence curves were generated using the Kaplan-
Meier method, and differences between the two
cohorts were analysed using the log-rank test. TB
incidence rate was expressed as the number of newly
diagnosed TB cases per 100 000 person-years (py).
The overall incidence rate ratio (IRR) of depression to
non-depression was calculated and further stratified
by other independent variables. We applied the
multivariable Cox proportional hazards model to
all independent variables after combining the two
cohorts to determine the hazard ratio (HR) of
depression on the development of TB. The multivar-
iable Cox proportional hazards model was reapplied
after categorisation of depression into mild and
severe sublevels to analyse changes in HR according
to depression severity. Analyses were performed using
SAS v9.3 (Statistical Analysis System, Cary, NC,
USA). Statistical significance was set at P , 0.05.
RESULTS
Characteristics of study subjects
A total of 32 396 patients newly diagnosed with
depression by a psychiatrist between 2003 and 2013
were identified from the NHIS-NSC. Of these, 24
were excluded as they were diagnosed with TB before
the diagnosis of depression. Finally, 32 372 patients
were included in the depression cohort. The control
cohort consisted of the same number of age- and sex-
matched subjects without any mood disorders. By the
end of 2013, respectively 101 and 191 patients with
newly diagnosed TB were identified in the depression
cohort and the control cohort (Figure 1).
Characteristics of the study cohort are summarised
in Table 1. In the depression cohort, female sex was
predominant (66.6%); the mean age 6 standard
deviation (SD) was 45.8 6 18.4 years. The propor-
tion of low-income subjects was lower in the
depression cohort than in the control cohort
(22.4% vs. 25.1%, P , 0.0001). The prevalence of
DM (0.6% vs. 22.6%, P , 0.0001) and COPD (0.1%
vs. 40.4%, P , 0.0001) was lower in the depression
cohort than in the control cohort, whereas that of
alcoholism was higher (3.4% vs. 0.6%, P , 0.0001).
Tuberculosis incidence
Cumulative TB incidence was significantly higher in
the depression cohort than in the control cohort (P ,
0.0001; log-rank test; Figure 2). The TB incidence
rate in the depression cohort was 60/100 000 py,
whereas in the control cohort this was 53/100 000 py.
The IRR of depression to non-depression in patients
with TB was 1.14 (95% confidence interval [CI]
806 The International Journal of Tuberculosis and Lung Disease

Table 1 Characteristics of the study cohort

Depression
Yes (n ¼ 32 372) No (n ¼ 32 372)
Variables n (%) n (%) P value
Sex 1.000
Male 10 813 (33.4) 10 813 (33.4)
Female 21 559 (66.6) 21 559 (66.6)
Age, years 1.000
624 4 696 (14.5) 4 696 (14.5)
25–34 5 004 (15.5) 5 004 (15.5)
35–44 5 728 (17.7) 5 728 (17.7)
45–54 6 148 (19.0) 6 148 (19.0)
55–64 4 749 (14.7) 4 749 (14.7)
765 6 047 (18.7) 6 047 (18.7)
Income level ,0.001
High 17 098 (52.8) 15 671 (48.4)
Middle 8 019 (24.8) 8 566 (26.5)
Low 7 255 (22.4) 8 135 (25.1)
DM ,0.001
Yes 200 (0.6) 7 324 (22.6)
No 32 172 (99.4) 25 048 (77.4)
COPD ,0.001
Figure 1 Flowchart showing enrolment from the National Yes 34 (0.1) 13 069 (40.4)
Health Insurance Service-National Sample Cohort. TB ¼ tuber- No 32 338 (99.9) 19 303 (59.6)
culosis. Alcoholism ,0.001
Yes 1 111 (3.4) 203 (0.6)
No 31 261 (96.6) 32 169 (99.4)
0.89–1.45). The IRR of depression to non-depression
DM ¼ diabetes mellitus; COPD ¼ chronic obstructive pulmonary disease.
in patients with TB was higher among male subjects
(1.40, 95%CI 0.97–2.03) and those with DM (1.49,
95%CI 0.21–10.8) than in female subjects (0.98, depression cohort than in the control cohort. Further-
95%CI 0.71–1.35) and those without DM, respec- more, male sex (HR 1.39, 95%CI 1.09–1.76, P ¼
tively (1.17, 95%CI 0.91–1.51; Table 2). 0.007), age 765 years (HR 1.48, 95%CI 1.01–2.16, P
¼ 0.045), DM (HR 2.45, 95%CI 1.55–3.88, P ,
Risk factors for tuberculosis 0.0001) and COPD (HR 3.46, 95%CI 2.31–5.18, P ,
The multivariable Cox proportional hazards model 0.0001) were significant risk factors for the develop-
with all independent variables revealed that the risk of ment of TB compared with female sex, age 624 years,
TB was 2.63-fold (95%CI 1.74–3.96) higher in the no DM and no COPD, respectively (Table 3).

Figure 2 Cumulative incidence of tuberculosis between the depression and control cohorts.
 Depression and risk of TB 807

Table 2 Tuberculosis incidence between the depression cohort and control cohort
Depression
Yes (n ¼ 32 372) No (n ¼ 32 372)
Variables n py Rate* n py Rate* IRR (95%CI)
All 101 167 271 60 191 359 265 53 1.14 (0.89–1.45)
Sex
Male 46 54 368 85 71 117 400 60 1.40 (0.97–2.03)
Female 55 112 904 49 120 241 864 50 0.98 (0.71–1.35)
Age, years
624 6 22 797 26 35 51 712 68 0.39 (0.16–0.92)
25–34 17 25 838 66 21 55 816 38 1.75 (0.92–3.31)
35–44 14 31 432 45 18 64 084 28 1.56 (0.79–3.19)
45–54 16 32 989 49 31 67 736 46 1.06 (0.58–1.94)
55–64 17 24 644 69 27 53 339 51 1.36 (0.74–2.50)
765 31 29 572 105 59 66 577 89 1.18 (0.77–1.83)
Income level
High 52 89 683 58 92 178 075 52 1.12 (0.80–1.58)
Middle 31 41 381 75 59 95 587 62 1.21 (0.79–1.87)
Low 18 36 207 50 40 85 603 47 1.06 (0.61–1.86)
DM
Yes 1 1 131 88 49 82 574 59 1.49 (0.21–10.8)
No 100 166 140 60 142 276 691 51 1.17 (0.91–1.51)
COPD
Yes 0 183 0 115 147 967 78 0
No 101 167 088 60 76 211 298 36 1.68 (1.25–2.26)
Alcoholism
Yes 7 5 150 136 0 2 125 0 —
No 94 162 121 58 191 357 139 53 1.08 (0.85–1.39)
*Incidence rate per 100 000 py.
py ¼ person-years; IRR ¼ incidence rate ratio; CI ¼ confidence interval; DM ¼ diabetes mellitus; COPD ¼ chronic
obstructive pulmonary disease.

In addition, the HR of mild depression was 1.99 DISCUSSION

(95%CI 1.21–3.28, P ¼ 0.007) and that of severe
Although depression has been assumed to be a risk
depression was 3.08 (95%CI 2.00–4.73, P ,
factor for TB due to its negative impact on cell-
0.0001) in the multivariable Cox proportional
mediated immunity, no studies have investigated the
hazards model after categorisation of depression
association between depression and the subsequent
into mild and severe sublevels. The risk of TB
risk of TB.9 To the best of our knowledge, this is the
showed a linear relationship with the severity of
first study to report that patients with depression are
depression (Figure 3).
at a higher risk of TB, and that a dose–response
relationship exists between depression severity and
the development of TB. Depression has been shown

Table 3 Multivariable analysis of factors associated with risk of

tuberculosis among all enrolees
Variables HR (95%CI)* P value
Depression 2.63 (1.74–3.96) ,0.001
Male sex 1.39 (1.09–1.76) 0.007
Age, years
25–34 0.82 (0.53–1.28) 0.382
35–44 0.57 (0.36–0.91) 0.019
45–54 0.75 (0.49–1.16) 0.193
55–64 0.88 (0.57–1.36) 0.560
765 1.48 (1.01–2.16) 0.045
Income level
Middle 1.30 (1.00–1.69) 0.054
Low 0.88 (0.65–1.20) 0.427
DM 2.45 (1.55–3.88) ,0.001
COPD 3.46 (2.31–5.18) ,0.001
Alcoholism 1.99 (0.92–4.31) 0.080
* Adjusted for depression, sex, age, income level, DM, COPD and alcoholism.
Figure 3 Hazard ratios (points) and 95% confidence intervals HR ¼ hazard ratio; CI ¼ confidence interval; DM ¼ diabetes mellitus; COPD ¼
(error bars) according to severity of depression. chronic obstructive pulmonary disease.
808 The International Journal of Tuberculosis and Lung Disease
to result in various immunological alterations, includ-
ing a reduction in the number and percentage of
lymphocytes and memory T-cell responses.12,13 Several
studies have therefore explored the association be-
tween depression and the development and progres-
sion of infectious diseases other than TB. Depression
can not only increase the risk of human immunode-
ficiency virus (HIV) infection, it can also contribute to
HIV progression by activating the hypothalamic–
pituitary–adrenal axis and induce a subsequent reduc-
tion in the number of CD4 T-lymphocytes.14,15
Furthermore, the IRR of pneumococcal disease in
people hospitalised with depression was found to be
2.1 (95%CI 2.0–2.1) in an English national data set
for the period 1999–2011.16
Our study also suggested that male sex, age 765
years, DM and COPD are significant risk factors for
TB, data that are consistent with the findings of
previous studies.4,8,17 The HR of DM in the present
study was within the range determined in a meta-
analysis of cohort studies (relative risk 3.11, 95%CI
2.27–4.26) by Jeon and Murray.4 In addition, the HR
of COPD in the present study was determined to be
analogous to that of a Swedish population-based
cohort study (HR 3.0, 95%CI 2.4–4.0).17 Although
the HR of alcoholism was not statistically significant,
it increased the risk of TB, an observation that is
consistent with the findings of previous studies.6,18
Our study had three main limitations. First, the
diagnoses of depression and TB were based on ICD-
10 codes and prescription history. ICD-10 codes were
used for the first round of screening, and prescrip-
tions of psychotherapy and anti-tuberculosis medica-
tions were subsequently used to confirm the
diagnoses of depression and TB, respectively. These
inclusion criteria might have limited sensitivity,
although they have higher specificity for these
diagnoses. In addition, depression severity was
classified on the basis of ICD-10 codes, whereby the
classification was mainly dependent on a psychia-
trist’s subjective judgement. However, the classifica-
tion is reliable to a certain extent as it is determined
on the basis of long-term observation by a psychia-
trist. Second, secondary changes caused by depression
were not sufficiently considered in the study. Depres-
sion is occasionally accompanied by smoking, alcohol
over-consumption, undernutrition and vitamin D
deficiency,19,20 all of which are established risk
factors for TB.3,5,6,21 As a result, the effect size of
the association between depression and TB develop-
ment might be attributable to both the primary and
secondary effects of depression. Although the NHIS-
NCC included the results of health examinations,
including the status of smoking and alcohol con-
sumption and body mass index, they were not
considered in the present study because more than
half of the values were not available. We attempted
instead to adjust for the effects of smoking and
alcohol overconsumption on the HR of depression by
including COPD, which is mainly attributed to
smoking,22 and clinically diagnosed alcoholism in
the analysis. Third, the controls were more likely to
have comorbidities than members of the general
population as they were selected from a medical
claims database between 2002 and 2013; healthy
people without any medical claims during the period
were thus excluded from the control cohort. None-
theless, the effect of major TB-associated comorbid-
ities on the HR of depression was minimised by
adjustment for these comorbidities in the analysis.
Despite these limitations, our study had two main
strengths. First, the exposure cohort was derived from
a nationwide population-based sample cohort as well
as being confirmed by a diagnosis of depression from
a psychiatrist. The depression cohort thus comprised
patients suffering from depression with national
representativeness, and was free of selection and
recall biases. Second, the large sample size and long-
term medical records of the NHIS-NSC increased the
statistical power and accuracy of the results.
The relationship between TB and NCDs has been
reported in several studies,23–25 and collaborative
frameworks for both disorders have been developed
accordingly.26,27 However, the bidirectional associa-
tion between TB and mental disorders has rarely been
explored.9 Further studies are required to elucidate
the inter-relationship between TB and mental disor-
ders. Furthermore, a collaborative framework for the
management of TB and mental disorders can be
developed when sufficient evidence has been ob-
tained.
In conclusion, our study suggests that patients with
depression are at a higher risk for developing TB, and
that a dose–response relationship exists between the
severity of depression and the subsequent risk of TB.
Steps should therefore be taken to promote and
improve TB care and prevention among patients with
depression.
Acknowledgements
Korean National Health Insurance Service-National Sample
Cohort data (NHIS-2015-2-078) established by the NHIS was
used for the study. The authors alone are responsible for the content
and writing of the manuscript.
Conflicts of interest: none declared.
References
1 World Health Organization. Global tuberculosis report, 2016.
WHO/HTM/TB/2016.13. Geneva, Switzerland: WHO; 2016.
2 Getahun H, Gunneberg C, Granich R, Nunn P. HIV infection-
associated tuberculosis: the epidemiology and the response.
Clin Infect Dis 2010; 50 (Suppl 3): S201–S207.
3 Lönnroth K, Williams B G, Cegielski P, Dye C. A consistent log-
linear relationship between tuberculosis incidence and body
mass index. Int J Epidemiol 2010; 39: 149–155.
4 Jeon C Y, Murray M B. Diabetes mellitus increases the risk of
active tuberculosis: a systematic review of 13 observational
studies. PLOS Med 2008; 5: e152.

5 Lin H H, Ezzati M, Murray M. Tobacco smoke, indoor air
pollution and tuberculosis: a systematic review and meta-
analysis. PLOS Med 2007; 4: e20.
6 Lönnroth K, Williams B G, Stadlin S, Jaramillo E, Dye C.
Alcohol use as a risk factor for tuberculosis—a systematic
review. BMC Public Health 2008; 8: 289.
7 Barboza C E, Winter D H, Seiscento M, Santos Ude P, Terra
Filho M. Tuberculosis and silicosis: epidemiology, diagnosis
and chemoprophylaxis. J Bras Pneumol 2008; 34: 959–966.
8 Rieder H L. Epidemiologic basis of tuberculosis control. Paris,
France: International Union Against Tuberculosis and Lung
Disease, 1999.
9 Prince M, Patel V, Saxena S, et al. No health without mental
health. Lancet 2007; 370: 859–877.
10 World Health Organization. The global burden of disease:
2004 update. Geneva, Switzerland: WHO; 2008.
11 Lee J, Lee J S, Park S H, Shin S A, Kim K. Cohort Profile: The
National Health Insurance Service-National Sample Cohort
(NHIS-NSC), South Korea. Int J Epidemiol 2016; Jan 28. pii:
dyv319. [Epub ahead of print].
12 Irwin M R, Miller A H. Depressive disorders and immunity: 20
years of progress and discovery. Brain Behav Immun 2007; 21:
374–383.
13 Zorrilla E P, Luborsky L, McKay J R, et al. The relationship of
depression and stressors to immunological assays: a meta-
analytic review. Brain Behav Immun 2001; 15: 199–226.
14 Koblin B A, Husnik M J, Colfax G, et al. Risk factors for HIV
infection among men who have sex with men. AIDS 2006; 20:
731–739.
15 Schuster R, Bornovalova M, Hunt E. The influence of
depression on the progression of HIV: direct and indirect
effects. Behav Modif 2012; 36: 123–145.
16 Seminog O O, Goldacre M J. Risk of pneumonia and
pneumococcal disease in people with severe mental illness:
English record linkage studies. Thorax 2013; 68: 171–176.
17 Inghammar M, Ekbom A, Engstrom G, et al. COPD and the
risk of tuberculosis—a population-based cohort study. PLOS
ONE 2010; 5: e10138.
Depression and risk of TB 809
18 Rehm J, Samokhvalov A V, Neuman M G, et al. The association
between alcohol use, alcohol use disorders and tuberculosis
(TB). A systematic review. BMC Public Health 2009; 9: 450.
19 Stein M, Miller A H, Trestman R L. Depression, the immune
system, and health and illness. Findings in search of meaning.
Arch Gen Psychiatry 1991; 48: 171–177.
20 Jozefowicz O, Rabe-Jablonska J, Wozniacka A, Strzelecki D.
Analysis of vitamin D status in major depression. J Psychiatr
Pract 2014; 20: 329–337.
21 Nnoaham K E, Clarke A. Low serum vitamin D levels and
tuberculosis: a systematic review and meta-analysis. Int J
Epidemiol 2008; 37: 113–119.
22 Vestbo J, Hurd S S, Agusti A G, et al. Global strategy for the
diagnosis, management, and prevention of chronic obstructive
pulmonary disease: GOLD executive summary. Am J Respir
Crit Care Med 2013; 187: 347–365.
23 Creswell J, Raviglione M, Ottmani S, et al. Tuberculosis and
noncommunicable diseases: neglected links and missed
opportunities. Eur Respir J 2011; 37: 1269–1282.
24 Marais B J, Lönnroth K, Lawn S D, et al. Tuberculosis
comorbidity with communicable and non-communicable
diseases: integrating health services and control efforts.
Lancet Infect Dis 2013; 13: 436–448.
25 Oh K H, Kim H J, Kim M H. Non-communicable diseases and
risk of tuberculosis in Korea. Int J Tuberc Lung Dis 2016; 20:
973–977.
26 World Health Organization & International Union Against
Tuberculosis and Lung Disease. Collaborative framework for
care and control of tuberculosis and diabetes. WHO/HTM/TB/
2011.15. Geneva, Switzerland: WHO, 2011.
27 World Health Organization & International Union Against
Tuberculosis and Lung Disease. A WHO/The Union
monograph on TB and tobacco control: joining efforts to
control two related global epidemics. WHO/HTM/TB/2007.
390. Geneva, Switzerland: WHO, 2007.

C O N T E X T E : Aucune étude n’a examiné l’association
entre la dépression et le risque de tuberculose (TB).
O B J E C T I F : Déterminer l’association entre la dépression
et le risque de TB.
M É T H O D E : A partir d’une base de données nationale,
les patients atteints de dépression ont été réunis comme
cohorte d’exposition entre 2003 et 2013. La cohorte
témoin a été composée du même nombre de sujets sans
troubles de l’humeur, chacun d’eux étant apparié à un
patient de la cohorte d’exposition en se basant sur l’âge
et le sexe. L’incidence de la TB a été identifiée dans la
cohorte d’exposition et dans la cohorte témoin entre
2003 et 2013. Le modèle de risque proportionnel
multivari é de Cox a été utilisé pour estimer
M A R C O D E R E F E R E N C I A: Ningún estudio hasta el
momento ha investigado la asociaci ón entre la
depresión y el riesgo de contraer la tuberculosis (TB).
O B J E T I V O: Determinar la asociación que existe entre la
depresión y el riesgo de padecer TB.
M É T O D O S: A partir de una base de datos de ámbito
nacional la cohorte expuesta a la depresión se conformó
con pacientes diagnosticados del 2003 al 2013. La
cohorte testigo consistió en el mismo número de
personas sin trastornos del afecto y cada una
emparejada con un paciente en función de la edad y el
sexo. Se determinó la incidencia de TB en la cohorte
expuesta y la cohorte testigo del 2003 al 2013. Mediante
un análisis multivariante con el modelo de riesgos
Depression and risk of TB i
RESUME
l’association entre la dépression et le risque ultérieur de
TB.
R É S U LT A T S : Un total de 32 372 patients atteints de
dépression et le même nombre de témoins ont été
identifiés. Le risque de TB dans la cohorte atteinte de
dépression a été 2,63 fois (IC95% 1,74–3,96) plus élevé
que dans la cohorte témoin. Quand la dépression a été
classée en niveaux modéré et grave, le risque de TB a été
proportionnel à la gravité de la dépression.
C O N C L U S I O N S : Les patients atteints de dépression ont
un risque plus élevé de TB et il existe une relation dose-
réponse entre la gravité de la dépression et le risque
ultérieur de TB.
RESUMEN
proporcionales de Cox se estimó la asociación entre la
depresión y el riesgo ulterior de padecer TB.
R E S U L T A D O S: Se escogieron 32 372 pacientes con
depresión y el mismo número de testigos. El riesgo de
contraer la TB en la cohorte de pacientes fue 2,63 veces
superior al riesgo en la cohorte testigo (IC95% de 1,74 a
3,96). Al clasificar la depresión en las categorı́as leve y
grave, el riesgo de padecer TB fue proporcional a la
gravedad de la depresión.
C O N C L U S I Ó N: Los pacientes con diagn óstico de
depresión presentan un riesgo más alto de contraer la
TB y existe una relación entre dosis y respuesta de la
depresión y el riesgo ulterior de padecer TB.