Volume 16, Number 10—October 2010
Dispatch
Type 2 Diabetes Mellitus and Increased Risk for Malaria Infection
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.