Time and risk factors for death among smear-positive pulmonary tuberculosis patients in the Health District of commune VI of Bamako, Mali, 2016

Time to Death and Associated Factors among Tuberculosis Patients in South West Ethiopia: Application of Shared Frailty Model

(1) Background: Tuberculosis is a bacterial disease mainly caused by Mycobacterium tuberculosis. It is one of the major public health problems in the world and now ranks alongside human immunodeficiency virus (HIV) as the leading infectious cause of death. The objective of this study was to investigate the potential risk factors affecting the time to death of TB patients in southwest Ethiopia using parametric shared frailty models. (2) Methods: A retrospective study design was used to collect monthly records of TB patients in three selected hospitals in southwest Ethiopia. The data used in the study were obtained from patients who took part in the directly observed treatment, short-course (DOTS) program from 1 January 2015 to 31 December 2019. The survival probability was analyzed by the Kaplan–Meier method. Log-rank tests and parametric shared frailty models were applied to investigate factors associated with death during TB treatment. (3) Results: Out of the total sample of 604 registered TB patients, 46 (7.6%) died during the study period and 558 (92.4%) were censored. It was found that the median time of death for TB patients was 5 months. Hospitals were used to assess the cluster effect of the frailty model. A Gamma shared frailty model with Weibull distribution for baseline hazard function was selected among all models considered and was used for this study. It was found that the covariates, age, initial weight, extrapulmonary type of TB patient, patient category, and HIV status of TB patient were significant risk factors associated with death status among TB patients. (4) Conclusions: The risk of death was high, especially with cases of HIV co-infected, retreated, and returned-after-treatment categories of TB patients. During the treatment period, the risk of death was high for older TB patients and patients with low baseline body weight measurements. Therefore, health professionals should focus on the identified factors to improve the survival time of TB patients.