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Volume 16, Number 10—October 2010

Dispatch

Type 2 Diabetes Mellitus and Increased Risk for Malaria Infection

Ina Danquah, George Bedu-Addo, and Frank P. MockenhauptComments to Author 
Author affiliations: Author affiliations: Institute of Tropical Medicine and International Health, Berlin, Germany (I. Danquah, F.P. Mockenhaupt); Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (G. Bedu-Addo)

Main Article

Table 2

Univariate and multivariate associations with Plasmodium falciparum infection, Kumasi, Ghana, 2007–2008*

Parameter Total no. patients P. falciparum infection, no. (%) Univariate analysis
Multivariate analysis
OR (95% CI) p value aOR (95% CI) p value
Diabetes mellitus type 2
No 791 81 (10.3) 1
Yes
675
108 (16.0)
1.67 (1.22–2.27)
0.001

1.46 (1.06–2.03)
0.021
Gender
F 1,113 124 (11.2) 1
M
353
65 (18.5)
1.80 (1.29–2.50)
<0.0001

2.13 (1.50–3.03)
<0.0001
Wealth score
>25th percentile 923 94 (10.2)
<25th percentile †
536
94 (17.6)
1.88 (1.38–2.56)
<0.0001

1.76 (1.27–2.42)
0.001
Literacy
Able to read 947 103 (10.9) 1
Unable to read
514
85 (16.6)
1.63 (1.20–2.23)
0.002

1.59 (1.11–2.28)
0.011
Formal education
Any 1,091 126 (11.6) 1
None
370
62 (16.8)
1.54 (1.11–2.15)
0.010



Living condition
Uncrowded 1,147 133 (11.6) 1
Crowded‡
297
52 (17.5)
1.61 (1.14–2.29)
0.007



Smoking
Never 1,380 171 (12.4) 1
Current or quit
84
18 (21.4)
1.92 (1.11–3.32)
0.019



Ethnicity
Akan 1,277 156 (12.3) 1
Others
188
33 (17.6)
1.52 (1.01–2.30)
0.045



Residence
Kumasi metropolitan 1,079 121 (11.2) 1
Kumasi outskirts 336 64 (19.2) 1.87 (1.34–2.61) <0.0001
Elsewhere §
48
4 (8.3)
0.72 (0.25–2.03)
0.533



Occupation
Public servant 238 17 (7.1) 1
Trader 388 50 (12.9) 1.92 (1.08–3.42) 0.026
Farmer 113 34 (30.6) 5.74 (3.04–10.86) <0.0001
Other¶ 335 38 (11.3) 1.66 (0.92–3.02) 0.095
Unemployed 386 49 (12.8) 1.90 (1.07–3.39) 0.029

*OR, odds ratio; CI, confidence interval; aOR, adjusted odds ratio. Age and gender were a priori included in the multivariate model. Further variables for inclusion in the model were identified by factor analysis excluding multicollinear parameters (1: retained diabetes, excluded occupation; 2: retained literacy, excluded education, smoking; 3: retained wealth, excluded living condition, ethnicity). The same model results from a logistic regression analysis initially including all above listed parameters, and then removing in a stepwise backward fashion all factors not associated with P. falciparum infection in multivariate analysis (p > 0.05). Inserting any of the excluded variables back into the model did not change the aOR of patients with type 2 diabetes mellitus by >7% each, suggesting the absence of substantial confounding. Leaving all parameters in the model yielded an aOR for patients with type 2 diabetes mellitus of 1.36 (95% CI, 0.98–1.90; p = 0.07). Alternatively, propensity score adjustment of that analysis, i.e. reducing covariates into a single variable, produced aOR = 1.41 (95% CI, 1.02–1.95; p = 0.04).
†<25th percentile of a calculated index of 11 markers of wealth.
‡Crowded living condition, >75th percentile of the number of persons living in the household, i.e., n>8.
§Hinterland and environs.
¶Includes casual labourer, artisan, and others.

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