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Salindri AD, Kipiani M, Lomtadze N, Tukvadze N, Avaliani Z, Blumberg HM, Masyn KE, Rothenberg RB, Kempker RR, Magee MJ. HIV co-infection increases the risk of post-tuberculosis mortality among persons who initiated treatment for drug-resistant tuberculosis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2023.05.19.23290190. [PMID: 37293036 PMCID: PMC10246159 DOI: 10.1101/2023.05.19.23290190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Little is known regarding the relationship between common comorbidities in persons with tuberculosis (TB) (including human immunodeficiency virus [HIV], diabetes, and hepatitis C virus [HCV]) with post-TB mortality. We conducted a retrospective cohort study among persons who initiated treatment for rifampicin-resistant and multi/extensively drug-resistant (RR and M/XDR) TB reported to the country of Georgia's TB surveillance during 2009-2017. Exposures included HIV serologic status, diabetes, and HCV status. Our outcome was all-cause post-TB mortality determined by cross-validating vital status with Georgia's death registry through November 2019. We estimated adjusted hazard rate ratios (aHR) and 95% confidence intervals (CI) of post-TB mortality among participants with and without comorbidities using cause-specific hazard regressions. Among 1032 eligible participants, 34 (3.3%) died during treatment and 87 (8.7%) died post-TB treatment. Among those who died post-TB treatment, the median time to death was 21 months (interquartile range 7-39) post-TB treatment. After adjusting for confounders, the hazard rates of post-TB mortality were higher among participants with HIV co-infection (aHR=3.74, 95%CI 1.77-7.91) compared to those without HIV co-infection. In our cohort, post-TB mortality occurred most commonly in the first three years post-TB treatment. Linkage to care for common TB comorbidities post-treatment may reduce post-TB mortality rates.
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Affiliation(s)
- Argita D. Salindri
- Department of Population Health Sciences, Georgia State University School of Public Health, Atlanta, GA, USA; and Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Maia Kipiani
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia; David Tvildiani Medical University, Tbilisi, Georgia; and The University of Georgia, Tbilisi, Georgia
| | - Nino Lomtadze
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia; David Tvildiani Medical University, Tbilisi, Georgia; and The University of Georgia, Tbilisi, Georgia
| | - Nestani Tukvadze
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia; and Department of Medicine, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
| | - Zaza Avaliani
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia; and European University, Tbilisi, Georgia
| | - Henry M. Blumberg
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA; Hubert Department of Global Health and Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Katherine E. Masyn
- Department of Population Health Sciences, Georgia State University School of Public Health, Atlanta, GA, USA, Atlanta, GA, USA
| | - Richard B. Rothenberg
- Department of Population Health Sciences, Georgia State University School of Public Health, Atlanta, GA, USA, Atlanta, GA, USA
| | - Russell R. Kempker
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Matthew J. Magee
- Hubert Department of Global Health and Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA; and Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Silva DR, Inwentarz S. Guidelines for the diagnosis and management of post-TB lung disease: a call to action. IJTLD OPEN 2024; 1:101-102. [PMID: 38966409 PMCID: PMC11221581 DOI: 10.5588/ijtldopen.24.0093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 02/23/2024] [Indexed: 07/06/2024]
Affiliation(s)
- D R Silva
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - S Inwentarz
- Instituto Vaccarezza, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
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Silva DR, Santos AP, Visca D, Bombarda S, Dalcolmo MMP, Galvão T, de Miranda SS, Parente AAAI, Rabahi MF, de Sales RKB, Migliori GB, Mello FCDQ. Brazilian Thoracic Association recommendations for the management of post-tuberculosis lung disease. J Bras Pneumol 2024; 49:e20230269. [PMID: 38198346 PMCID: PMC10760438 DOI: 10.36416/1806-3756/e20230269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 09/29/2023] [Indexed: 01/12/2024] Open
Abstract
Historically, all efforts against tuberculosis were focused on rapid diagnosis and effective treatment to break the chain of transmission of Mycobacterium tuberculosis. However, in the last few years, more and more evidence has been found on the dramatic consequences of the condition defined as post-tuberculosis lung disease (PTLD). Approximately one third of patients surviving pulmonary tuberculosis face considerable ongoing morbidities, including respiratory impairment, psychosocial challenges, and reduced health-related quality of life after treatment completion. Given the important global and local burden of tuberculosis, as well as the estimated burden of PTLD, the development of a consensus document by a Brazilian scientific society-Sociedade Brasileira de Pneumologia e Tisiologia (SBPT)-was considered urgent for the prevention and management of this condition in order to allocate resources to and within tuberculosis services appropriately and serve as a guide for health care professionals. A team of eleven pulmonologists and one methodologist was created by the SBPT to review the current evidence on PTLD and develop recommendations adapted to the Brazilian context. The expert panel selected the topics on the basis of current evidence and international guidelines. During the first phase, three panel members drafted the recommendations, which were divided into three sections: definition and prevalence of PTLD, assessment of PTLD, and management of PTLD. In the second phase, all panel members reviewed, discussed, and revised the recommendations until a consensus was reached. The document was formally approved by the SBPT in a special session organized during the 2023 SBPT Annual Conference.
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Affiliation(s)
- Denise Rossato Silva
- . Faculdade de Medicina, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil
| | - Ana Paula Santos
- . Instituto de Doenças do Tórax, Universidade Federal do Rio de Janeiro - UFRJ - Rio de Janeiro (RJ) Brasil
- . Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro - UERJ - Rio de Janeiro (RJ) Brasil
| | - Dina Visca
- . Dipartimento di Pneumologia Riabilitativa, Istituti Clinici Scientifici Maugeri - IRCCS - Tradate, Italia
- . Dipartimento di Medicina e Chirurgia, Malattie Respiratorie, Università Degli Studi Dell’Insubria, Varese-Como, Italia
| | - Sidney Bombarda
- . Secretaria de Estado da Saúde de São Paulo, Centro de Vigilância Epidemiológica Professor Alexandre Vranjac - CVE-SSP-SP - São Paulo (SP) Brasil
| | | | - Tatiana Galvão
- . Hospital Universitário Professor Edgar Santos. Universidade Federal da Bahia - UFBA - Salvador (BA) Brasil
| | | | | | | | - Roberta Karla Barbosa de Sales
- . Divisão de Pneumologia, Instituto do Coração - InCor - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Giovanni Battista Migliori
- . Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri - IRCCS - Tradate, Italia
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Malefane L, Maarman G. Post-tuberculosis lung disease and inflammatory role players: can we characterise the myriad inflammatory pathways involved to gain a better understanding? Chem Biol Interact 2024; 387:110817. [PMID: 38006959 DOI: 10.1016/j.cbi.2023.110817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/31/2023] [Accepted: 11/20/2023] [Indexed: 11/27/2023]
Abstract
Tuberculosis (TB) remains a global health threat, and even after successful TB treatment, a subset of patients develops serious long-term lung impairments, recently termed post-tuberculosis lung disease (PTLD). Much remains to be discovered, as PTLD as a post-TB disease is a developing field, still in its infancy. The pathogenesis of PTLD is not fully elucidated but has been linked to elevated inflammatory pathways. The complexity of PTLD makes it challenging to pinpoint the specific inflammatory pathways involved in its pathophysiology. Therefore, this paper provides a comprehensive review of inflammatory cytokines and their potential roles in PLTD, with a specific focus on interleukin 6 (IL-6), IL-1, IL-8, tumour necrosis factor-alpha (TNF-α), transforming growth factor beta (TGF-β) and C-Reactive Protein (CRP). We delve into PTLD pathology, discuss its impact on lung function and review risk factors for PTLD. In addition, we summarise the current gaps in knowledge, provide recommendations for measuring inflammatory biomarkers and propose potential directions for future studies. We propose that future studies measure a wide range of inflammatory markers in TB populations with and without PTLD. In addition, studies could isolate peripheral blood mononuclear cells from patient blood to try and identify possible impairments that could be correlated with a PTLD diagnosis. Given that the PTLD field is still in an early stage of development, a comprehensive inflammatory analysis may help to know which pathways are key in PTLD development, and this may ultimately help to predict patients who are at risk. More research is warranted.
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Affiliation(s)
- Lindiwe Malefane
- CARMA: Centre for Cardio-Metabolic Research in Africa, Division of Medical Physiology, Department of Biomedical Sciences, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, 8000, South Africa
| | - Gerald Maarman
- CARMA: Centre for Cardio-Metabolic Research in Africa, Division of Medical Physiology, Department of Biomedical Sciences, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, 8000, South Africa.
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Seo W, Kim HW, Kim JS, Min J. Long term management of people with post-tuberculosis lung disease. Korean J Intern Med 2024; 39:7-24. [PMID: 38225822 PMCID: PMC10790047 DOI: 10.3904/kjim.2023.395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/24/2023] [Accepted: 11/08/2023] [Indexed: 01/17/2024] Open
Abstract
Post-tuberculosis lung disease (PTLD) is emerging as a significant area of global interest. As the number of patients surviving tuberculosis (TB) increases, the subsequent long-term repercussions have drawn increased attention due to their profound clinical and socioeconomic impacts. A primary obstacle to its comprehensive study has been its marked heterogeneity. The disease presents a spectrum of clinical manifestations which encompass tracheobronchial stenosis, bronchiectasis, granulomas with fibrosis, cavitation with associated aspergillosis, chronic pleural diseases, and small airway diseases-all persistent consequences of PTLD. The spectrum of symptoms a patient may experience varies based on the severity of the initial infection and the efficacy of the treatment received. As a result, the long-term management of PTLD necessitates a detailed and specific approach, addressing each manifestation individually-a tailored strategy. In the immediate aftermath (0-12 months after anti-TB chemotherapy), there should be an emphasis on monitoring for relapse, tracheobronchial stenosis, and smoking cessation. Subsequent management should focus on addressing hemoptysis, managing infection including aspergillosis, and TB-associated chronic obstructive pulmonary disease or restrictive lung function. There remains a vast expanse of knowledge to be discovered in PTLD. This review emphasizes the pressing need for comprehensive, consolidated guidelines for management of patients with PTLD.
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Affiliation(s)
- Wan Seo
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Hyung Woo Kim
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Ju Sang Kim
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Jinsoo Min
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
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Cupido G, Günther G. Post tuberculosis lung disease and tuberculosis sequelae: A narrative review. Indian J Tuberc 2024; 71:64-72. [PMID: 38296392 DOI: 10.1016/j.ijtb.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 03/28/2023] [Accepted: 04/05/2023] [Indexed: 02/08/2024]
Abstract
Post Tuberculosis lung disease (PTLD) and post tuberculosis sequelae is a global and poorly recognized problem, amplified by social factors and immunocompromising conditions, inadequate treatment, lack of effective prevention of tuberculosis (TB) infection and disease. As a disease, it remained until recently poorly defined, with studies heterogenous with regards to regions, population demographics, risk factors, cohort sizes, and methods. Pathophysiologically, even successfully treated pulmonary TB disease has sequelae i.e. involving central and peripheral airways, lung parenchyma and pleura, resulting in airway narrowing and dilatation, fibrocavitation and emphysema, pulmonary vascular changes as well as pleural fibrosis. Functionally patients have airflow limitation, restrictive disease or a mixture of both not rarely associated with respiratory, or even ventilatory failure. Quality of life is often impaired through disability, TB relapse, superinfections and through increased susceptibility to reinfection and persistent inflammation, leading to progressive lung function decline and an increased risk of cardiovascular disease and cancer. Premature mortality due to PTLD is very likely, but poorly described.
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Affiliation(s)
- Gordon Cupido
- Department of Internal Medicine, Katutura State Hospital, Windhoek, Namibia.
| | - Gunar Günther
- Department of Pulmonology and Allergology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Medical Sciences, University of Namibia, School of Medicine, Windhoek, Namibia
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Acharya S, Karanjkar V, Bhamre SP, Palkar A, Rathod D, Setia MS. Factors associated with mortality in HIV-TB co-infected patients during and after the course of TB treatment in high-burden settings, Mumbai, India: A cohort analysis. Trop Med Int Health 2024; 29:23-32. [PMID: 38093552 DOI: 10.1111/tmi.13948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND Knowledge of factors associated with TB mortality during treatment and post treatment will help us develop better monitoring and implementation strategies for TB control. We designed the present study to examine the factors associated with mortality in HIV-TB co-infected patients during and after the course of TB treatment. METHODS This study is a cohort analysis of secondary data collected from 1804 HIV-TB co-infected individuals from 16 anti-retroviral therapy (ART) centres affiliated with the Mumbai Districts AIDS Control Society, Mumbai, India. We used Kaplan Meier survival curves and hazard ratios to estimate the mortality in patients. RESULTS The overall mortality rate in this cohort was 1.14 per 100 per month. The mortality proportion was 18% (95% CI: 16.1%, 20.1%) during treatment and 10.6% (95% CI: 8.9%, 12.5%) in the post-treatment period. Mortality was significantly higher in those with a CD4 count 0-200 cells/mm3 (HR: 3.04, 95% CI: 2.13, 4.15; p < 0.001), and in patients who were ART naïve and referred to the ART centre with a diagnosis of TB (HR: 1.39, 95% CI: 1.06, 1.82; p = 0.016). Mortality was also significantly higher in the first 6 months after initiation of ART (HR: 1.36, 95% CI: 1.06, 1.75; p = 0.016). A decrease in the CD4 counts from initial levels at start of TB treatment to end of TB treatment was associated with higher mortality in the post-treatment period. DISCUSSION The overall mortality remains high; early identification of TB and HIV disease, and use of rapid point of care tests for diagnosis of TB are needed across all health care facilities. Post-treatment follow-up and monitoring is important in HIV-TB co-infected patients, and post-treatment mortality should also be considered as one of the indicators for successful TB control programmes.
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Affiliation(s)
- Shrikala Acharya
- Project Management, Mumbai Districts AIDS Control Society, Mumbai, India
- Department of Community Medicine, Seth G S Medical College and KEM Hospital, Mumbai, India
| | | | - Sunil P Bhamre
- Project Management, Maharashtra State AIDS Control Society, Mumbai, India
| | - Amol Palkar
- Monitoring and Evaluation, UW International Training and Education Center for Health, Mumbai, India
| | - Dhirubhai Rathod
- Project Management, Mumbai Districts AIDS Control Society, Mumbai, India
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Sy KTL, Horváth-Puhó E, Sørensen HT, Szépligeti SK, Heeren TC, Thomsen RW, Fox MP, Horsburgh, Jr. CR. Burden of Chronic Obstructive Pulmonary Disease Attributable to Tuberculosis: A Microsimulation Study. Am J Epidemiol 2023; 192:908-915. [PMID: 36813297 PMCID: PMC10505413 DOI: 10.1093/aje/kwad042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 12/18/2022] [Accepted: 02/20/2023] [Indexed: 02/24/2023] Open
Abstract
Tuberculosis (TB) is a risk factor for chronic obstructive pulmonary disease (COPD), but COPD is also a predictor of TB. The excess life-years lost to COPD caused by TB can potentially be saved by screening for and treating TB infection. We examined the number of life-years that could be saved by preventing TB and TB-attributable COPD. We compared the observed (no intervention) and counterfactual microsimulation models constructed from observed rates in the Danish National Patient Registry (covering all Danish hospitals between 1995 and 2014). In the Danish population of TB and COPD-naive individuals (n = 5,206,922), 27,783 persons (0.5%) developed TB. Among those who developed TB, 14,438 (52.0%) developed TB with COPD. Preventing TB saved 186,469 life-years overall. The excess number of life-years lost to TB alone was 7.07 years per person, and the additional number of life-years lost among persons who developed COPD after TB was 4.86 years per person. The life-years lost to TB-associated COPD are substantial, even in regions where TB can be expected to be identified and treated promptly. Prevention of TB could prevent a substantial amount of COPD-related morbidity; the benefit of screening and treatment for TB infection is underestimated by considering morbidity from TB alone.
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Affiliation(s)
- Karla Therese L Sy
- Correspondence to Dr. Karla Therese Sy, Department of Epidemiology, School of Public Health, Boston University, Boston, MA 02118 (e-mail: )
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Lumu I, Musaazi J, Semeere A, Handel I, Castelnuovo B. Survival and predictors of mortality after completion of TB treatment among people living with HIV: a 5-year analytical cohort. BMC Infect Dis 2023; 23:238. [PMID: 37072726 PMCID: PMC10111785 DOI: 10.1186/s12879-023-08217-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 04/03/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND After completion of TB treatment patients may remain at risk of co-morbidity and mortality. We determined the survival and predictors of all-cause mortality after completing TB treatment among ART-experienced patients. METHODS This was a retrospective cohort analysis of all ART experienced patients who completed TB treatment at a specialist HIV clinic in Uganda, between 2009 and 2014. The patients were followed for five years after TB treatment. We determined the cumulative probability of death, and predictors of mortality using Kaplan-Meier methods and Cox proportional hazard models, respectively. RESULTS A total 1,287 patients completed TB treatment between 2009 and 2014, of which 1,111 were included in the analysis. At TB treatment completion, the median age was 36 years (IQR: 31-42), 563 (50.7%) were males, and median CD4 cell count was 235 cells/mL (IQR: 139-366). The person-time at risk was 4410.60 person-years. The all-cause mortality rate was 15.42 (95% CI: 12.14-19.59) per 1000 person-years. The probability of death at five years was 6.9% (95%CI: 5.5- 8.8). In the multivariable analysis, CD4 count < 200 cells/mL was a predictor of all-cause mortality (aHR = 1.81, 95%CI:1.06-3.11, p = 0.03) alongside history of retreatment (aHR = 2.12, 95%CI: 1.16-3.85, p = 0.01). CONCLUSION Survival post TB treatment in ART experienced PLHIV is reasonably good. Most deaths occur within two years after TB treatment completion. Patients with a low CD4 count and those with a history of retreatment have an increased risk of mortality which underscores the need for TB prophylaxis, detailed assessment, and close monitoring after completion of TB treatment.
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Affiliation(s)
- Ivan Lumu
- Infectious Diseases Institute - College of Health Sciences, Makerere University, P.O. Box 22418, Kampala, Uganda.
- Edinburgh Medical School, University of Edinburgh, Edinburgh, United Kingdom.
| | - Joseph Musaazi
- Infectious Diseases Institute - College of Health Sciences, Makerere University, P.O. Box 22418, Kampala, Uganda
| | - Aggrey Semeere
- Infectious Diseases Institute - College of Health Sciences, Makerere University, P.O. Box 22418, Kampala, Uganda
| | - Ian Handel
- Edinburgh Medical School, University of Edinburgh, Edinburgh, United Kingdom
| | - Barbara Castelnuovo
- Infectious Diseases Institute - College of Health Sciences, Makerere University, P.O. Box 22418, Kampala, Uganda
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Association of Sociodemographic Factors with Tuberculosis Outcomes in Mississippi. Diseases 2023; 11:diseases11010025. [PMID: 36810538 PMCID: PMC9944444 DOI: 10.3390/diseases11010025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/09/2023] [Accepted: 01/29/2023] [Indexed: 02/04/2023] Open
Abstract
Tuberculosis (TB) is one of the leading causes of death worldwide. In the US, the national incidence of reported TB cases was 2.16 per 100,000 persons in 2020 and 2.37 per 100,000 persons in 2021. Furthermore, TB disproportionately affects minorities. Specifically, in 2018, 87% of reported TB cases occurred in racial and ethnic minorities in Mississippi. Data from TB patients from the Mississippi Department of Health (2011-2020) were used to examine the association between sociodemographic subgroups (race, age, place of birth, gender, homelessness, and alcohol use) with TB outcome variables. Of the 679 patients with active TB cases in Mississippi, 59.53% were Black, and 40.47% were White. The mean age was 46 ± ten years; 65.1% were male, and 34.9% were female. Among patients with previous TB infections, 70.8% were Black, and 29.2% were White. The rate of previous TB cases was significantly higher among US-born (87.5%) persons compared with non-US-born persons (12.5%). The study suggested that sociodemographic factors play a significant role in TB outcome variables. This research will help public health professionals to develop an effective TB intervention program that addresses sociodemographic factors in Mississippi.
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Müller A, Osório C, Figueiredo R, Silva D, Dalcin P. Post-discharge mortality in adult patients hospitalized for tuberculosis: a prospective cohort study. Braz J Med Biol Res 2023; 56:e12236. [PMID: 36722657 PMCID: PMC9883006 DOI: 10.1590/1414-431x2023e12236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 11/30/2022] [Indexed: 01/31/2023] Open
Abstract
Determining outcomes and predictors of mortality following discharge from tuberculosis (TB) hospitalization is crucial to establish health policies. The objective of this study was to analyze outcomes and, secondarily, predictors of mortality following discharge from TB hospitalization. This was a prospective cohort study of patients diagnosed with TB (all forms) discharged from the hospital who began treatment during hospitalization. Out of 169 subjects included, 38 died during the 13-months of follow-up, within a median of 3 months (95%CI: 1.49-4.51). In the multivariate analysis, the variables independently associated with death were age (HR=1.04, 95%CI: 1.01-1.06, P=0.001), presence of sputum production (HR=2.18, 95%CI: 1.09-4.34, P=0.027), and Charlson Comorbidity Index (HR=1.19, 95%CI: 1.04-1.36, P=0.015). In conclusion, post-discharge mortality in subjects hospitalized for TB was 22.5%, with mean survival of 4.6 months. The mortality was higher in older subjects, in those who reported sputum production, and in those with a high comorbidity index.
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Affiliation(s)
- A.M. Müller
- Programa de Pós-Graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - C.S. Osório
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - R.V. Figueiredo
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - D.R. Silva
- Programa de Pós-Graduação em Ciências Pneumológicas, Serviço de Pneumologia, Hospital de Clínicas de Porto Alegre, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - P.T.R. Dalcin
- Programa de Pós-Graduação em Ciências Pneumológicas, Serviço de Pneumologia, Hospital de Clínicas de Porto Alegre, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
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Choi H, Han K, Jung JH, Park SH, Kim SH, Kang HK, Sohn JW, Shin DW, Lee H. Long-Term Mortality of Tuberculosis Survivors in Korea: A Population-based Longitudinal Study. Clin Infect Dis 2022; 76:e973-e981. [PMID: 35616107 PMCID: PMC9907525 DOI: 10.1093/cid/ciac411] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/04/2022] [Accepted: 05/19/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND When assessing long-term tuberculosis (TB) mortality, few studies addressed the impact of behavior habits and socioeconomic status. Therefore, we aimed to evaluate long-term TB mortality and risk factors while accounting for potential confounders. METHODS This cohort study included TB survivors (n = 82 098) aged ≥20 years between 2010 and 2017, and 1:1 age- and sex-matched controls (n = 82 098). The participants were followed up for death 1 year after study enrollment until December 2018. Long-term mortality was adjusted for behavior habits (smoking, alcohol consumption, or exercise), income level, body mass index (BMI), and comorbidities. RESULTS During a median of 3.7 years of follow-up, the incidence rate of mortality was significantly higher in TB survivors than those in the matched controls (18.2 vs. 8.8 per 1000 person-years, P < .001). Even after adjusting for potential confounders, the mortality risk was 1.62-fold (95% confidence interval [CI], 1.54-1.70) higher in TB survivors than those in the matched controls. In addition, the hazard of mortality in TB survivors relative to matched controls significantly increased in participants aged ≥30 years, with the highest risk in those in their 40s. Male sex (adjusted hazard ratio [HR]: 2.31; 95% CI, 2.16-2.47), smoking pack-years (HR: 1.005; 95% CI, 1.004-1.006), heavy alcohol consumption (HR: 1.12; 95% CI, 1.01-1.23), and lowest income (HR: 1.27; 95% CI, 1.18-1.37) were positively associated with increased hazards for mortality, whereas higher BMI (HR: 0.91; 95% CI, .90-.92) and regular exercise (HR: 0.82; 95% CI, .76-.88) reduced the hazards of long-term mortality in TB survivors. CONCLUSIONS The long-term mortality risk was significantly higher in TB survivors than those in the matched controls, even after adjusting for potential confounders.
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Affiliation(s)
- Hayoung Choi
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Jin-Hyung Jung
- Department of Biostatistics, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
| | - Sang Hyun Park
- Department of Biostatistics, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
| | - Sang Hyuk Kim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of Korea
| | - Hyung Koo Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - Jang Won Sohn
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang Medical Center, Hanyang University College of Medicine, Seoul, Republic of Korea
| | | | - Hyun Lee
- Correspondence: H. Lee, MD, PhD, Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang Medical Center, Hanyang University College of Medicine, Seoul, Republic of Korea, 222-1 Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea ()
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13
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Kazempour-Dizaji M, Varahram M, Tabarsi P, Roozbahani R, Zare A, Emamhadi MA, Marjani M, Abedini A, Moniri A, Madani M, Baghaei Shiva P. Evaluations of Factors Affecting of Short-and Long-Time of Occurrence of Disease Relapse in Patients with Tuberculosis Using Parametric Mixture Cure Model: A Cohort Study. TANAFFOS 2022; 21:70-77. [PMID: 36258908 PMCID: PMC9571239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 09/09/2021] [Indexed: 11/04/2022]
Abstract
Background The success of treatment strategies to control the disease relapse requires determining factors affecting the incident short-time and long-time of disease relapse. Therefore, this study was aimed to identify the factors affecting of short-and long-time of occurrence of disease relapse in patients with tuberculosis (TB) using a parametric mixture cure model. Materials and Methods In this historical cohort study; the data was collected from 4564 patients with TB who referred to the Tuberculosis and Lung Diseases Research Center of Dr. Masih Daneshvari Hospital from 2005 to 2015. In order to evaluate the factors affecting of short-and long-time of occurrence of disease relapse, a parametric mixture cure model was used. Results In this study, the estimation of the annual incidence of TB relapse showed that the probability of recurrence in the first year is 1% and in the third and tenth years after treatment is 3% and 5%, respectively. In addition, the results of this study showed that the variables of residence, exposure to cigarette smoke, adverse effects of drug use, incarceration, and pulmonary and extra- pulmonary tuberculosis were the factors affecting the short-time recurrence of TB. The variables of drug use, pulmonary and extra- pulmonary tuberculosis, and also incarceration affected the long-term recurrence of this disease. Conclusion Cure models by separating factors affecting the short-time occurrence from the long-time occurrence of disease relapse can provide more accurate information to researchers to control and reduce TB relapse.
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Affiliation(s)
- Mehdi Kazempour-Dizaji
- Mycobacteriology Research Center (MRC), National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran,,Department of Biostatistics, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran,,Correspondence to: Kazempour- Dizaji M Address: Mycobacteriology Research Center (MRC), NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran Email address:
| | - Mohammad Varahram
- Mycobacteriology Research Center (MRC), National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Payam Tabarsi
- Clinical Tuberculosis and Epidemiology Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Rahim Roozbahani
- Clinical Tuberculosis and Epidemiology Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Zare
- Department of Biostatistics, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Emamhadi
- Department Forensic Medicine, School of Medicine Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Marjani
- Clinical Tuberculosis and Epidemiology Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atefe Abedini
- Chronic Respiratory Diseases Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Afshin Moniri
- Clinical Tuberculosis and Epidemiology Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Madani
- Chronic Respiratory Diseases Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parvaneh Baghaei Shiva
- Clinical Tuberculosis and Epidemiology Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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14
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An E-value analysis of potential unmeasured or residual confounding in systematic reviews of post-tuberculosis mortality, respiratory disease, and cardiovascular disease. Ann Epidemiol 2021; 68:24-31. [DOI: 10.1016/j.annepidem.2021.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 11/25/2021] [Accepted: 12/15/2021] [Indexed: 11/19/2022]
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15
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Loveday M, Hlangu S, Larkan LM, Cox H, Daniels J, Mohr-Holland E, Furin J. "This is not my body": Therapeutic experiences and post-treatment health of people with rifampicin-resistant tuberculosis. PLoS One 2021; 16:e0251482. [PMID: 34662887 PMCID: PMC8523213 DOI: 10.1371/journal.pone.0251482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/27/2021] [Indexed: 11/19/2022] Open
Abstract
Background There are few data on the on post-treatment experiences of people who have been successfully treated for rifampicin-resistant (RR-)TB. Objective To describe the experiences and impact of RR-TB disease and therapy on post-treatment life of individuals who were successfully treated. Methods In this qualitative study in-depth interviews were conducted among a purposively selected sample from a population of individuals who were successfully treated for RR-TB between January 2008 and December 2018. Interview transcripts and notes were analysed using a thematic network analysis which included grounded theory and a framework for understanding pathophysiological mechanisms for post-TB morbidity and mortality. The analysis was iterative and the coding system developed focused on disease, treatment and post-treatment experiences of individuals. This paper follows the COREQ guidelines. Results For all 12 participants interviewed, the development of RR-TB disease, its diagnosis and the subsequent treatment were a major disruption to their lives as well as a transformative experience. On diagnosis of RR-TB disease, participants entered a liminal period in which their lives were marked with uncertainty and dominated by physical and mental suffering. Irrespective of how long ago they had completed their treatment, they all remembered with clarity the signs and symptoms of the disease and the arduous treatment journey. Post-treatment participants reported physical, social, psychological and economic changes as consequences of their RR-TB disease and treatment. Many participants reported a diminished ability to perform physical activities and, once discharged from the RR-TB hospital, inadequate physical rehabilitation. For some, these physical limitations impacted on their social life, and ultimately on their psychological health as well as on their ability to earn money and support their families. Conclusion The experiences and impact of RR-TB disease and therapy on post-treatment life of individuals successfully treated, highlights gaps in the current health care system that need to be addressed to improve the life of individuals post-treatment. A more holistic and long-term view of post-TB health, including the provision of comprehensive medical and social services for post-treatment care of physical ailments, social re-integration and the mitigation of the perceived fear and risk of getting TB again could be a central part of person-centred TB care.
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Affiliation(s)
- Marian Loveday
- HIV Prevention Research Unit, South African Medical Research Council, KwaZulu-Natal, South Africa
- CAPRISA-MRC HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
- * E-mail:
| | - Sindisiwe Hlangu
- HIV Prevention Research Unit, South African Medical Research Council, KwaZulu-Natal, South Africa
| | - Lee-Megan Larkan
- Greytown Specialised TB Hospital, KwaZulu-Natal Department of Health, Pietermaritzburg, South Africa
| | - Helen Cox
- Institute for Infectious Disease and Molecular Medicine and Wellcome Centre for Infectious Disease Research in Africa, University of Cape Town, Cape Town, South Africa
| | - Johnny Daniels
- Médecins Sans Frontières, Khayelitsha, Cape Town, South Africa
| | | | - Jennifer Furin
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America
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16
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Impact of post-tuberculosis lung disease on health-related quality of life in patients from two tertiary hospitals in Lagos, Nigeria. Afr J Thorac Crit Care Med 2021; 27. [PMID: 34430871 PMCID: PMC8327683 DOI: 10.7196/ajtccm.2021.v27i2.135] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2021] [Indexed: 12/20/2022] Open
Abstract
Background
Post-tuberculosis (TB) lung disease is a recognised cause of chronic respiratory disease, and its impact on health-related quality
of life (HRQoL) has not been extensively described.
Objectives
To describe the clinical profile, spirometry impairment and impact of post-TB lung disease on HRQoL among patients attending
two tertiary hospitals in Lagos, Nigeria.
Methods
We conducted a cross-sectional study and obtained data through interviews, chart reviews and physical examination. We measured
dyspnoea severity using the Medical Research Council (MRC) scale, HRQoL with the St George’s respiratory questionnaire (SGRQ) and
performed spirometry. Univariate regression was used to explore the associations between selected variables and HRQoL.
Results
A total of 59 participants were recruited and their median (interquartile range (IQR)) age was 45 (36 - 60) years. The most frequent
symptom was cough (93.2%; n=55) and sputum production (91.5%; n=54). Less than two-thirds of the participants (62.4%; n=38) had
received treatment for TB on more than one occasion, 50.8% (n=30) had moderate to very severe dyspnoea on the MRC scale and 88.7%
(n=47/53) had abnormal spirometry with the mixed pattern predominating in 56.6% (n=30) of the participants. The mean (standard
deviation (SD)) SGRQ component score for symptoms was 43.89 (18.66), followed by activity (42.50 (22.68)), impact (29.41 (17.82)) and
total components (35.78 (17.25)). Dyspnoea, cough, sputum production and weight loss were associated with worsened HRQoL.
Conclusion
Post-TB lung disease was characterised by a high symptom burden, severe spirometry impairment and poor HRQoL. There is
a need for increased recognition and development of guidelines for diagnosis and treatment of post-TB lung disease and for further studies
to explore preventive strategies.
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17
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Rao VG, Muniyandi M, Sharma RK, Yadav R, Bhat J. Long-term survival of patients treated for tuberculosis: a population-based longitudinal study in a resource-poor setting. Trop Med Int Health 2021; 26:1110-1116. [PMID: 34109699 DOI: 10.1111/tmi.13636] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We assessed the long-term survival of TB patients belonging to the Saharia tribe, a high TB burden community in Shivpuri district, Madhya Pradesh, central India. METHODS Population-based, longitudinal study conducted among 9756 Saharia population in 2013, and a resurvey done 2 years later in 2015 using the same methods. The status of the individuals during resurvey was recorded as non-TB, relapse and death. The deaths recorded in this period were used to measure the mortality among TB-affected population and the non-TB population in this cohort. RESULTS The standardised mortality ratio for the study cohort was 122.9 per 1000 population; males had higher mortality than females (129.9 vs. 96.8). The expected mortality among the non-TB population was 30.2, and the observed mortality among TB-affected population was 122.9 per 1000 population. CONCLUSION In the Saharia tribe, post-treatment mortality in the TB-affected population is significantly higher than in the general population. This highlights an urgent need for implementation of effective public health strategies to prevent disproportionate deaths among TB-affected individuals in resource-poor settings, and the importance of periodic follow-up of patients after cure/completion of treatment, especially in vulnerable populations.
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Affiliation(s)
- V G Rao
- National Institute of Research in Tribal Health, Jabalpur, India
| | - M Muniyandi
- National Institute for Research in Tuberculosis, Chennai, India
| | - R K Sharma
- National Institute of Medical Statistics, New Delhi, India
| | - R Yadav
- National Institute of Research in Tribal Health, Jabalpur, India
| | - Jyothi Bhat
- National Institute of Research in Tribal Health, Jabalpur, India
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18
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Joseph Y, Yao Z, Dua A, Severe P, Collins SE, Bang H, Antoine Jean‐Juste M, Ocheretina O, Apollon A, McNairy ML, Dupnik K, Cremieux E, Byrne A, Pape JW, Koenig SP. Long-term mortality after tuberculosis treatment among persons living with HIV in Haiti. J Int AIDS Soc 2021; 24:e25721. [PMID: 34235862 PMCID: PMC8264404 DOI: 10.1002/jia2.25721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/11/2021] [Accepted: 04/09/2021] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Long-term mortality among TB survivors appears to be higher than control populations without TB in many settings. However, data are limited among persons with HIV (PWH). We assessed the association between cured TB and long-term mortality among persons with PWH in Haiti. METHODS A prospective cohort of PWH from the CIPRA HT-001 trial was followed from study enrolment (August 2005 to July 2008) to study closure (December 2018) to compare mortality between participants with and without TB. The index date for the survival analysis was defined as 240 days after TB diagnosis or randomization date. Time to death was described using Kaplan-Meier curves, and log-rank tests were used to compare time to death between the TB and no-TB cohorts. The association between TB and long-term mortality was estimated with multivariable Cox models. RESULTS Of the 816 participants in the CIPRA HT-001 trial, 77 were excluded for a history of TB prior to study enrolment and 31 were excluded due to death or attrition prior to the index date, leaving 574 in the no-TB and 134 in the TB cohort. Twenty-four (17.9%) participants in the TB and 48 (8.4%) in the no-TB cohort died during follow-up. Five and 10-year mortality rates were 14.2% and 17.9% respectively, in the TB cohort, and 6.1% and 8.4% in the no-TB cohort. In Kaplan-Meier analysis, participants in the TB cohort had a significantly shorter time to death (log-rank p < 0.001). In multivariable analysis, TB treatment was the only predictor of mortality (HR: 2.78; 95% CI: 1.61, 4.79). Sensitivity analyses, which included only baseline TB cases, an index date of two years after TB diagnosis, and study enrolment and case-control matching yielded results that were consistent with primary analyses. CONCLUSIONS PWH who are successfully treated for TB have higher long-term mortality than those who are never diagnosed with TB, even after accounting for acute TB-related mortality. A better understanding of the underlying mechanisms associated with TB sequelae is critically needed to guide specific interventions. Until then, more aggressive measures for health promotion and disease prevention are essential to improve long-term survival for PWH after TB treatment.
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Affiliation(s)
- Yvetot Joseph
- Haitian Study Group for Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO)Port‐au‐PrinceHaiti
| | | | | | - Patrice Severe
- Haitian Study Group for Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO)Port‐au‐PrinceHaiti
| | - Sean E Collins
- Haitian Study Group for Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO)Port‐au‐PrinceHaiti
| | - Heejung Bang
- Division of BiostatisticsDepartment of Public Health SciencesUniversity of CaliforniaDavisCAUSA
| | - Marc Antoine Jean‐Juste
- Haitian Study Group for Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO)Port‐au‐PrinceHaiti
| | - Oksana Ocheretina
- Center for Global HealthDepartment of MedicineWeill Cornell Medical CollegeNew YorkNYUSA
| | - Alexandra Apollon
- Haitian Study Group for Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO)Port‐au‐PrinceHaiti
| | - Margaret L McNairy
- Center for Global HealthDepartment of MedicineWeill Cornell Medical CollegeNew YorkNYUSA
| | - Kathryn Dupnik
- Center for Global HealthDepartment of MedicineWeill Cornell Medical CollegeNew YorkNYUSA
| | - Etienne Cremieux
- Haitian Study Group for Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO)Port‐au‐PrinceHaiti
| | - Anthony Byrne
- Department of MedicineUniversity of New South WalesSydneyNSWAustralia
| | - Jean W Pape
- Haitian Study Group for Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO)Port‐au‐PrinceHaiti
| | - Serena P Koenig
- Division of Global Health EquityBrigham and Women’s HospitalHarvard Medical SchoolBostonMAUSA
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19
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Tatar M, Wilson FA. The largest vaccination campaign in history: A golden opportunity for bundling public health interventions. J Glob Health 2021; 11:03076. [PMID: 34055326 PMCID: PMC8141326 DOI: 10.7189/jogh.11.03076] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Moosa Tatar
- Matheson Center for Health Care Studies, University of Utah, Salt Lake City, Utah, USA.,Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Fernando A Wilson
- Matheson Center for Health Care Studies, University of Utah, Salt Lake City, Utah, USA.,Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA.,Department of Economics, University of Utah, Salt Lake City, Utah, USA
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20
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Allwood BW, Stolbrink M, Baines N, Louw E, Wademan DT, Lupton-Smith A, Nel S, Maree D, Mpagama S, Osman M, Marx FM, Hoddinott G, Lesosky M, Rylance J, Mortimer K. Persistent chronic respiratory symptoms despite TB cure is poorly correlated with lung function. Int J Tuberc Lung Dis 2021; 25:262-270. [PMID: 33762069 PMCID: PMC8009599 DOI: 10.5588/ijtld.20.0906] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND: Persistent respiratory symptoms and lung function deficits are common after patients with TB. We aimed to define the burden of post-TB lung disease (PTLD) and assess associations between symptoms and impairment in two high TB incidence communities.METHODS: This was a cross-sectional survey of adults in Cape Town, South Africa who completed TB treatment 1-5 years previously. Questionnaires, spirometry and 6-minute walking distance (6MWD) were used to assess relationships between outcome measures and associated factors.RESULTS: Of the 145 participants recruited (mean age: 42 years, range: 18-75; 55 [38%] women), 55 (38%) had airflow obstruction and 84 (58%) had low forced vital capacity (FVC); the mean 6MWD was 463 m (range: 240-723). Respiratory symptoms were common: chronic cough (n = 27, 19%), wheeze (n = 61, 42%) and dyspnoea (modified MRC dyspnoea score 3 or 4: n = 36, 25%). There was poor correlation between FVC or obstruction and 6MWD. Only low body mass index showed consistent association with outcomes on multivariable analyses. Only 19 (13%) participants had a diagnosis of respiratory disease, and 16 (11%) currently received inhalers.CONCLUSION: There was substantial burden of symptoms and physiological impairment in this "cured" population, but poor correlation between objective outcome measures, highlighting deficits in our understanding of PTLD.
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Affiliation(s)
- B W Allwood
- Division of Pulmonology, Department of Medicine, Stellenbosch University & Tygerberg Hospital, Tygerberg, South Africa
| | - M Stolbrink
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - N Baines
- Division of Pulmonology, Department of Medicine, Stellenbosch University & Tygerberg Hospital, Tygerberg, South Africa
| | - E Louw
- Division of Pulmonology, Department of Medicine, Stellenbosch University & Tygerberg Hospital, Tygerberg, South Africa
| | - D T Wademan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - A Lupton-Smith
- Department of Science and Innovation-National Research Foundation South African Centre for Excellence in Epidemiological Modelling and Analysis (SACEMA), Faculty of Science, Stellenbosch University, Stellenbosch, South Africa
| | - S Nel
- Department of Physical Medicine and Rehabilitation, School of Medicine, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - D Maree
- Division of Pulmonology, Department of Medicine, Stellenbosch University & Tygerberg Hospital, Tygerberg, South Africa
| | - S Mpagama
- Kibong´oto Infectious Diseases Hospital, Kilimanjaro, Tanzania
| | - M Osman
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - F M Marx
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa, Department of Science and Innovation-National Research Foundation South African Centre for Excellence in Epidemiological Modelling and Analysis (SACEMA), Faculty of Science, Stellenbosch University, Stellenbosch, South Africa
| | - G Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - M Lesosky
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, South Africa, Liverpool School of Tropical Medicine, Liverpool, UK
| | - J Rylance
- Lung Health Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi, Liverpool School of Tropical Medicine, Liverpool, UK
| | - K Mortimer
- Liverpool School of Tropical Medicine, Liverpool, UK
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21
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Wong YJ, Noordin NM, Keshavjee S, Lee SWH. Impact of latent tuberculosis infection on health and wellbeing: a systematic review and meta-analysis. Eur Respir Rev 2021; 30:30/159/200260. [PMID: 33408089 DOI: 10.1183/16000617.0260-2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 09/25/2020] [Indexed: 12/29/2022] Open
Abstract
The impact of latent tuberculosis infection (LTBI) on health and wellbeing is not well understood. This review aims to evaluate the health and wellbeing of individuals with LTBI. A systematic literature search was performed to assess studies reporting patient-reported outcomes in LTBI management including health-related quality of life (HRQoL), health utilities, disease burden and experience of individuals with LTBI. A pooled analysis was performed to estimate the effect of LTBI on HRQoL.A total of 4464 studies were screened, of which 13 eligible articles describing nine unique studies were included for review. The HRQoL of individuals with LTBI and without tuberculosis (TB) infection were comparable, and better than patients with active TB disease. However, individuals with LTBI reported poorer mental health compared with individuals without TB infection (mean difference -4.16, 95% CI -7.45- -0.87; p=0.01). Qualitative studies suggest the presence of fear, anxiety and stigma in individuals with LTBI.This review highlights potential psychosocial challenges in individuals with LTBI despite the absence of clinical symptoms. While their quality of life was marginally affected, this could be evidence to support LTBI management in preventing TB re-activation and the severe consequences of active TB disease that affect all domains of HRQoL.
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Affiliation(s)
- Yen Jun Wong
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia
| | | | - Salmaan Keshavjee
- Dept of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Shaun Wen Huey Lee
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia .,Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Subang Jaya, Malaysia.,Gerontechnology Laboratory, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Subang Jaya, Malaysia.,School of Pharmacy, Taylor's University Lakeside Campus, Subang Jaya, Malaysia
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22
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Koenig SP, Kim A, Shepherd BE, Cesar C, Veloso V, Cortes CP, Padgett D, Crabtree-Ramírez B, Gotuzzo E, McGowan CC, Sterling TR, Pape JW. Increased Mortality After Tuberculosis Treatment Completion in Persons Living With Human Immunodeficiency Virus in Latin America. Clin Infect Dis 2021; 71:215-217. [PMID: 31629369 DOI: 10.1093/cid/ciz1032] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 10/14/2019] [Indexed: 12/24/2022] Open
Abstract
We assessed the association between cured tuberculosis (TB) and mortality among persons living with human immunodeficiency virus (HIV) in Latin America. We compared survival among persons with and without TB at enrollment in HIV care, starting 9 months after clinic enrollment. In multivariable analysis, TB was associated with higher long-term mortality (hazard ratio, 1.57; 95% confidence interval, 1.25-1.99).
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Affiliation(s)
- Serena P Koenig
- Le Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes, Port-au-Prince, Haiti.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ahra Kim
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Bryan E Shepherd
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Carina Cesar
- Fundación Huésped, Investigaciones Clínicas, Buenos Aires, Argentina
| | - Valdilea Veloso
- Instituto Nacional de Infectiologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Claudia P Cortes
- Fundación Arriarán, University of Chile School of Medicine, Santiago, Chile
| | - Denis Padgett
- Instituto Hondureño de Seguridad Social and Hospital Escuela Universitario, Tegucigalpa, Honduras
| | - Brenda Crabtree-Ramírez
- Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Departmento de Infectología, Mexico City, Mexico
| | - Eduardo Gotuzzo
- Universidad Peruana Cayetano Heredia, Instituto de Medicina Tropical Alexander von Humboldt, Lima, Peru
| | - Catherine C McGowan
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Timothy R Sterling
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jean W Pape
- Le Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes, Port-au-Prince, Haiti.,Center for Global Health, Weill Cornell Medicine, New York City, New York, USA
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23
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Basham CA, Karim ME, Cook VJ, Patrick DM, Johnston JC. Post-tuberculosis airway disease: A population-based cohort study of people immigrating to British Columbia, Canada, 1985-2015. EClinicalMedicine 2021; 33:100752. [PMID: 33718847 PMCID: PMC7933261 DOI: 10.1016/j.eclinm.2021.100752] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/23/2021] [Accepted: 01/26/2021] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Current epidemiological evidence of post-TB airway disease is largely cross-sectional and derived from high-TB-incidence settings. We present the first cohort study of post-TB airway disease in a low-TB-incidence setting. AIMS (1) analyze the risk of airway disease by respiratory TB, (2) assess potential unmeasured confounding between TB and airway disease, and (3) investigate TB effect measure modification. METHODS A population-based cohort study using healthcare claims data for immigrants to British Columbia (BC), Canada, 1985-2015. Airway disease included chronic airway obstruction, asthma, bronchitis, bronchiolitis, and emphysema. Respiratory TB was defined from TB registry data. Cox proportional hazards (PH) regressions were used to analyze time-to-airway disease by respiratory TB. Sensitivity analyses included varying definitions of TB and airway disease. Potential unmeasured confounding by smoking was evaluated by E-value and hybrid least absolute shrinkage and selection operator (LASSO)-high-dimensional propensity score (hdPS). FINDINGS In our cohort (N = 1 005 328; nTB=1141) there were 116 840 incident cases of airway disease during our 30-year study period (10.43 per 1,000 person-years of follow-up), with cumulative incidence of 42·5% among respiratory TB patients compared with 11·6% among non-TB controls. The covariate-adjusted hazard ratio (aHR) for airway disease by respiratory TB was 2·08 (95% CI: 1·91-2·28) with E-value=3·58. The LASSO-hdPS analysis produced aHR=2·26 (95% CI: 2·07-2·47). INTERPRETATION A twofold higher risk of airway disease was observed among immigrants diagnosed with respiratory TB, compared with non-TB controls, in a low-TB-incidence setting. Unmeasured confounding is unlikely to explain this relationship. Models of post-TB care are needed. FUNDING Canadian Institutes of Health Research.
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Affiliation(s)
- C. Andrew Basham
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- British Columbia Centre for Disease Control, Vancouver, Canada
- Corresponding author at: 655W 12th Avenue, Vancouver, British Columbia, V5Z 4R4 Canada.
| | - Mohammad E. Karim
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- Centre for Health Evaluative and Outcome Sciences, University of British Columbia, Vancouver, Canada
| | - Victoria J. Cook
- British Columbia Centre for Disease Control, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - David M. Patrick
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- British Columbia Centre for Disease Control, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - James C. Johnston
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- British Columbia Centre for Disease Control, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
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Basham CA, Karim ME, Cook VJ, Patrick DM, Johnston JC. Post-tuberculosis mortality risk among immigrants to British Columbia, Canada, 1985-2015: a time-dependent Cox regression analysis of linked immigration, public health, and vital statistics data. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2021; 112:132-141. [PMID: 32666352 PMCID: PMC7851220 DOI: 10.17269/s41997-020-00345-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/14/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To compare non-tuberculosis (non-TB)-cause mortality risk overall and cause-specific mortality risks within the immigrant population of British Columbia (BC) with and without TB diagnosis through time-dependent Cox regressions. METHODS All people immigrating to BC during 1985-2015 (N = 1,030,873) were included with n = 2435 TB patients, and the remaining as non-TB controls. Outcomes were time-to-mortality for all non-TB causes, respiratory diseases, cardiovascular diseases, cancers, and injuries/poisonings, and were ascertained using ICD-coded vital statistics data. Cox regressions were used, with a time-varying exposure variable for TB diagnosis. RESULTS The non-TB-cause mortality hazard ratio (HR) was 4.01 (95% CI 3.57-4.51) with covariate-adjusted HR of 1.69 (95% CI 1.50-1.91). Cause-specific covariate-adjusted mortality risk was elevated for respiratory diseases (aHR = 2.96; 95% CI 2.18-4.00), cardiovascular diseases (aHR = 1.63; 95% CI 1.32-2.02), cancers (aHR = 1.40; 95% CI 1.13-1.75), and injuries/poisonings (aHR = 1.85; 95% CI 1.25-2.72). CONCLUSIONS In any given year, if an immigrant to BC was diagnosed with TB, their risk of non-TB mortality was 69% higher than if they were not diagnosed with TB. Healthcare providers should consider multiple potential threats to the long-term health of TB patients during and after TB treatment. TB guidelines in high-income settings should address TB survivor health.
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Affiliation(s)
- C Andrew Basham
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
- British Columbia Centre for Disease Control, 655 W 12th Ave., Vancouver, BC, V5Z 4R4, Canada.
| | - Mohammad Ehsanul Karim
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Centre for Health Evaluation and Outcomes Science, University of British Columbia, Vancouver, BC, Canada
| | - Victoria J Cook
- British Columbia Centre for Disease Control, 655 W 12th Ave., Vancouver, BC, V5Z 4R4, Canada
- Division of Respiratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - David M Patrick
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- British Columbia Centre for Disease Control, 655 W 12th Ave., Vancouver, BC, V5Z 4R4, Canada
| | - James C Johnston
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- British Columbia Centre for Disease Control, 655 W 12th Ave., Vancouver, BC, V5Z 4R4, Canada
- Division of Respiratory Medicine, University of British Columbia, Vancouver, BC, Canada
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Allwood BW, Byrne A, Meghji J, Rachow A, van der Zalm MM, Schoch OD. Post-Tuberculosis Lung Disease: Clinical Review of an Under-Recognised Global Challenge. Respiration 2021; 100:751-763. [PMID: 33401266 DOI: 10.1159/000512531] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/20/2020] [Indexed: 11/19/2022] Open
Abstract
An estimated 58 million people have survived tuberculosis since 2000, yet many of them will suffer from post-tuberculosis lung disease (PTLD). PTLD results from a complex interplay between organism, host, and environmental factors and affects long-term respiratory health. PTLD is an overlapping spectrum of disorders that affects large and small airways (bronchiectasis and obstructive lung disease), lung parenchyma, pulmonary vasculature, and pleura and may be complicated by co-infection and haemoptysis. People affected by PTLD have shortened life expectancy and increased risk of recurrent tuberculosis, but predictors of long-term outcomes are not known. No data are available on PTLD in children and on impact throughout the life course. Risk-factors for PTLD include multiple episodes of tuberculosis, drug-resistant tuberculosis, delays in diagnosis, and possibly smoking. Due to a lack of controlled trials in this population, no evidence-based recommendations for the investigation and management of PTLD are currently available. Empirical expert opinion advocates pulmonary rehabilitation, smoking cessation, and vaccinations (pneumococcal and influenza). Exacerbations in PTLD remain both poorly understood and under-recognised. Among people with PTLD, the probability of tuberculosis recurrence must be balanced against other causes of symptom worsening. Unnecessary courses of repeated empiric anti-tuberculosis chemotherapy should be avoided. PTLD is an important contributor to the global burden of chronic lung disease. Advocacy is needed to increase recognition for PTLD and its associated economic, social, and psychological consequences and to better understand how PTLD sequelae could be mitigated. Research is urgently needed to inform policy to guide clinical decision-making and preventative strategies for PTLD.
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Affiliation(s)
- Brian W Allwood
- Division of Pulmonology, Department of Medicine, Stellenbosch University, Stellenbosch, South Africa
| | - Anthony Byrne
- Heart Lung Clinic, St Vincent's Hospital Clinical School, University of New South Wales, St. Vincent, New South Wales, Australia
| | - Jamilah Meghji
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Andrea Rachow
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany
- German Centre for Infection Research (DZIF), Partner Site, Munich, Germany
| | - Marieke M van der Zalm
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch, South Africa
| | - Otto Dagobert Schoch
- Lung Center, Cantonal Hospital St. Gallen and University of Zurich, St. Gallen, Switzerland,
- Tuberculosis Competence Center, Swiss Lung Association, Berne, Switzerland,
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Cost-Effectiveness Analysis of BCG Vaccination against Tuberculosis in Indonesia: A Model-Based Study. Vaccines (Basel) 2020; 8:vaccines8040707. [PMID: 33256143 PMCID: PMC7711585 DOI: 10.3390/vaccines8040707] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/13/2020] [Accepted: 11/20/2020] [Indexed: 11/21/2022] Open
Abstract
Bacillus Calmette–Guerin (BCG), the only available vaccine for tuberculosis (TB), has been applied for decades. The Indonesian government recently introduced a national TB disease control programme that includes several action plans, notably enhanced vaccination coverage, which can be strengthened through underpinning its favourable cost-effectiveness. We designed a Markov model to assess the cost-effectiveness of Indonesia’s current BCG vaccination programme. Incremental cost-effectiveness ratios (ICERs) were evaluated from the perspectives of both society and healthcare. The robustness of the analysis was confirmed through univariate and probabilistic sensitivity analysis (PSA). Using epidemiological data compiled for Indonesia, BCG vaccination at a price US$14 was estimated to be a cost-effective strategy in controlling TB disease. From societal and healthcare perspectives, ICERs were US$104 and US$112 per quality-adjusted life years (QALYs), respectively. The results were robust for variations of most variables in the univariate analysis. Notably, the vaccine’s effectiveness regarding disease protection, vaccination costs, and case detection rates were key drivers for cost-effectiveness. The PSA results indicated that vaccination was cost-effective even at US$175 threshold in 95% of cases, approximating the monthly GDP per capita. Our findings suggest that this strategy was highly cost-effective and merits prioritization and extension within the national TB programme. Our results may be relevant for other high endemic low- and middle-income countries.
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Lee-Rodriguez C, Wada PY, Hung YY, Skarbinski J. Association of Mortality and Years of Potential Life Lost With Active Tuberculosis in the United States. JAMA Netw Open 2020; 3:e2014481. [PMID: 32965497 PMCID: PMC7512053 DOI: 10.1001/jamanetworkopen.2020.14481] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
IMPORTANCE Active tuberculosis (TB) disease leads to substantial mortality but is preventable through screening and treatment for latent TB infection. Early mortality after TB diagnosis (≤1 year) is well described, but delayed mortality (>1 year) among patients with active TB is poorly understood. OBJECTIVE To compare early and delayed mortality and years of potential life (YPL) lost among patients with active TB disease vs an age-, sex-, and year of diagnosis-matched comparison cohort without active TB disease. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study, conducted in the integrated health system of Kaiser Permanente Northern California, included patients with microbiologically confirmed active TB disease from January 1, 1997, to December 31, 2017, and a control cohort matched by age, sex, and year of diagnosis. Multivariable models were used to adjust for demographic and clinical characteristics. Patients with active TB disease prior to 1997 were excluded. Data were analyzed from January 1, 2019, to January 31, 2020. EXPOSURE Microbiologically confirmed TB disease. MAIN OUTCOMES AND MEASURES Early (≤1 year after TB diagnosis) and delayed (>1 year after TB diagnosis) all-cause mortality. RESULTS A total of 2522 patients who had active TB from 1997 to 2017 were identified, with 17 166 person-years of follow-up. The comparison cohort included 100 880 persons with 735 726 person-years of follow-up. In the active TB and comparison cohorts, similar percentages of persons were male (56.3% vs 55.6%), aged 45 to 64 years (33.7% vs 33.7%), and aged 65 years or older (24.7% vs 24.7%). Both early mortality (7.0%) and delayed mortality (16.3%) were higher among patients with active TB disease compared with those without active TB disease (1.1% and 12.0%, respectively). Patients with active TB disease had a significantly higher risk for early (adjusted hazard ratio [aHR], 7.29; 95% CI, 6.08-8.73) and delayed (aHR, 1.78; 95% CI, 1.61-1.98) mortality compared with the comparison cohort (P < .001). Active TB disease was associated with an adjusted -7.0 (95% CI, -8.4 to -5.5) YPL lost compared with the comparison cohort. CONCLUSIONS AND RELEVANCE In this study, patients with active TB disease had significantly higher early and delayed all-cause mortality when adjusting for demographic and clinical characteristics. These findings suggest that TB prevention through screening and treatment of latent TB infection could reduce mortality and YPL lost due to active TB disease.
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Affiliation(s)
- Christian Lee-Rodriguez
- Internal Medicine Residency Program, Oakland Medical Center, Kaiser Permanente Northern California, Oakland
| | - Paul Y. Wada
- Internal Medicine Residency Program, Oakland Medical Center, Kaiser Permanente Northern California, Oakland
| | - Yun-Yi Hung
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Jacek Skarbinski
- Division of Research, Kaiser Permanente Northern California, Oakland
- Department of Infectious Diseases, Oakland Medical Center, Kaiser Permanente Northern California, Oakland
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Fox GJ, Nguyen VN, Dinh NS, Nghiem LPH, Le TNA, Nguyen TA, Nguyen BH, Nguyen HD, Tran NB, Nguyen TL, Le TN, Nguyen VH, Phan TL, Nguyen KC, Ho J, Pham DC, Britton WJ, Bestrashniy JRBM, Marks GB. Post-treatment Mortality Among Patients With Tuberculosis: A Prospective Cohort Study of 10 964 Patients in Vietnam. Clin Infect Dis 2020; 68:1359-1366. [PMID: 30202910 DOI: 10.1093/cid/ciy665] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 08/14/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Tuberculosis is the leading infectious cause of death. Steep reductions in tuberculosis-related mortality are required to realize the World Health Organization's "End Tuberculosis Strategy." However, accurate mortality estimates are lacking in many countries, particularly following discharge from care. This study aimed to establish the mortality rate among patients with pulmonary tuberculosis in Vietnam and to quantify the excess mortality in this population. METHODS We conducted a prospective cohort study among adult patients treated for smear-positive pulmonary tuberculosis in 70 clinics across Vietnam. People living in the same households were recruited as controls. Participants were re-interviewed and their survival was established at least 2 years after their treatment with an 8-month standardized regimen. The presence of relapse was established by linking identifying data on patients and controls to clinic registries. Verbal autopsies were performed. The cumulative mortality among patients was compared to that among a control population, adjusting for age and gender. RESULTS We enrolled 10964 patients and 25707 household controls. Among enrolled tuberculosis patients, 9% of patients died within a median follow-up period of 2.9 years: 342 (3.1%) during treatment and 637 (5.8%) after discharge. The standardized mortality ratio was 4.0 (95% confidence interval 3.7-4.2) among patients with tuberculosis, compared to the control population. Tuberculosis was the likely cause of death for 44.7% of these deceased patients. CONCLUSIONS Patients treated for tuberculosis had a markedly elevated risk of death, particularly in the post-treatment period. Interventions to reduce tuberculosis mortality must enhance the early detection of drug-resistance, improve treatment effectiveness, and address non-communicable diseases.
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Affiliation(s)
- G J Fox
- Faculty of Medicine and Health, University of Sydney, Australia.,Woolcock Institute of Medical Research, Glebe, New South Wales, Australia
| | - V N Nguyen
- National Lung Hospital, Ba Dinh, Hanoi, Vietnam
| | - N S Dinh
- National Lung Hospital, Ba Dinh, Hanoi, Vietnam
| | - L P H Nghiem
- Woolcock Institute of Medical Research, Glebe, New South Wales, Australia
| | - T N A Le
- National Lung Hospital, Ba Dinh, Hanoi, Vietnam
| | - T A Nguyen
- Woolcock Institute of Medical Research, Glebe, New South Wales, Australia
| | - B H Nguyen
- National Lung Hospital, Ba Dinh, Hanoi, Vietnam.,Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, Paris, France
| | - H D Nguyen
- Pham Ngoc Thach Hospital, Ho Chi Minh City, Vietnam
| | - N B Tran
- Woolcock Institute of Medical Research, Glebe, New South Wales, Australia
| | - T L Nguyen
- Woolcock Institute of Medical Research, Glebe, New South Wales, Australia
| | - T N Le
- Woolcock Institute of Medical Research, Glebe, New South Wales, Australia
| | - V H Nguyen
- Woolcock Institute of Medical Research, Glebe, New South Wales, Australia
| | - T L Phan
- Woolcock Institute of Medical Research, Glebe, New South Wales, Australia
| | - K C Nguyen
- National Lung Hospital, Ba Dinh, Hanoi, Vietnam.,Hanoi Medical University, Hanoi, Vietnam
| | - J Ho
- Faculty of Medicine and Health, University of Sydney, Australia
| | - D C Pham
- Woolcock Institute of Medical Research, Glebe, New South Wales, Australia
| | - W J Britton
- Faculty of Medicine and Health, University of Sydney, Australia.,Centenary Institute of Cancer Medicine and Cell Biology, University of Sydney, Camperdown, New South Wales, Australia
| | | | - G B Marks
- Woolcock Institute of Medical Research, Glebe, New South Wales, Australia.,South Western Sydney Clinical School, University of New South Wales, Kensington, New South Wales, Australia
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Ranzani OT, Rodrigues LC, Bombarda S, Minto CM, Waldman EA, Carvalho CRR. Long-term survival and cause-specific mortality of patients newly diagnosed with tuberculosis in São Paulo state, Brazil, 2010-15: a population-based, longitudinal study. THE LANCET. INFECTIOUS DISEASES 2020; 20:123-132. [PMID: 31676242 PMCID: PMC6928568 DOI: 10.1016/s1473-3099(19)30518-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 08/28/2019] [Accepted: 09/06/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Long-term survival and cause-specific mortality of patients who start tuberculosis treatment is rarely described. We aimed to assess the long-term survival of these patients and evaluate the association between vulnerable conditions (social, health behaviours, and comorbidities) and cause-specific mortality in a country with a high burden of tuberculosis. METHODS In this population-based, longitudinal study in São Paulo state, Brazil, we described the 5-year survival of patients who were newly diagnosed with tuberculosis in 2010. We included patients with newly-diagnosed tuberculosis, aged 15 years or older, and notified to the São Paulo State Tuberculosis Program in 2010. We excluded patients whose diagnosis had changed during follow-up (ie, they did not have tuberculosis) and patients who had multidrug-resistant (MDR) tuberculosis. We selected our population with tuberculosis from the dedicated electronic system TBweb. Our primary objective was to estimate the excess mortality over 5 years and within the group who survived the first year, compared with the general São Paulo state population. We also estimated the association between social vulnerability (imprisonment and homelessness), health behaviours (alcohol and drug use), and comorbidities (diabetes and mental disorders) with all-cause and cause-specific mortality. We used the competing risk analysis framework, estimating cause-specific hazard ratios (HRs) adjusted for potential confounding factors. FINDINGS In 2010, there were 19 252 notifications of tuberculosis cases. We excluded 550 cases as patients were younger than 15 years, 556 cases that were not tuberculosis, 2597 retreatments, and 48 cases of MDR tuberculosis, resulting in a final cohort of 15 501 patients with tuberculosis. Over a period of 5 years from tuberculosis diagnosis, 2660 (17%) of 15 501 patients died. Compared with the source population, matched by age, sex, and calendar year, the standardised mortality ratio was 6·47 (95% CI 6·22-6·73) over 5 years and 3·93 (3·71-4·17) among those who survived the first year. 1197 (45%) of 2660 deaths were due to infection. Homelessness and alcohol and drug use were associated with death from infection (adjusted cause-specific HR 1·60, 95% CI 1·39-1·85), cardiovascular (1·43, 1·06-1·95), and external or ill-defined causes of death (1·80, 1·37-2·36). Diabetes was associated with deaths from cardiovascular causes (1·70, 1·23-2·35). INTERPRETATION Patients newly diagnosed with tuberculosis were at a higher risk of death than were the source population, even after tuberculosis treatment. Post-tuberculosis sequelae and vulnerability are associated with excess mortality and must be addressed to mitigate the tuberculosis burden worldwide. FUNDING Wellcome Trust.
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Affiliation(s)
- Otavio T Ranzani
- Pulmonary Division, Heart Institute (InCor), Hospital das Clinicas (HCFMUSP), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; London School of Hygiene & Tropical Medicine, London, UK.
| | | | - Sidney Bombarda
- São Paulo Tuberculosis Program, Epidemiological Surveillance Centre "Prof Alexandre Vranjac", São Paulo Secretary of Health, São Paulo, Brazil
| | - Cátia M Minto
- Centro de Informações em Vigilância em Saúde (CIVS), Coordenadoria de Controle de Doenças, São Paulo Secretary of Health, São Paulo, Brazil
| | - Eliseu A Waldman
- Department of Epidemiology, Faculty of Public Health, University of São Paulo, São Paulo, Brazil
| | - Carlos R R Carvalho
- Pulmonary Division, Heart Institute (InCor), Hospital das Clinicas (HCFMUSP), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Medina A, López L, Martínez C, Aguirre S, Alarcón E. [Factors associated with tuberculosis mortality in Paraguay, 2015-2016Fatores associados à mortalidade por tuberculose no Paraguai, 2015-2016]. Rev Panam Salud Publica 2019; 43:e102. [PMID: 31892928 PMCID: PMC6922078 DOI: 10.26633/rpsp.2019.102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 10/31/2019] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To describe the socio-demographic and clinical-epidemiological characteristics and to determine the factors associated with the mortality of people diagnosed with tuberculosis (TB) in Paraguay. METHODS Operational research with a retrospective cohort design of cases diagnosed with TB in Paraguay between 2015-2016. The database of the National Tuberculosis Control Program was used. Chi-square and relative risk (RR) tests with a 95% confidence interval (95% CI) were used to determine the factors associated with mortality; in addition, a robust Poisson multiple regression model was adjusted. A significance level of 5% was used. RESULTS Five hundred and forty-one cases of TB were studied, of which 11.5% died. The factors increasing the risk of death were male sex (RR 1.26; 95% CI 1.1-1.50), infection with human immunodeficiency virus (RR 4.78; 95% CI 4.04-5.65) and chronic obstructive pulmonary disease (RR 1.70; 95% CI 1.19-2.42). Being deprived of one's liberty was a protective factor (RR 0.37; 95% CI 0.24-0.61). CONCLUSIONS The highest risk of death is presented by men and people with TB/HIV coinfection and the lowest risk is presented by people deprived of liberty. There is a need to improve diagnosis and follow-up of TB cases, with effective implementation of directly observed treatment (DOTS) and timely management of associated diseases such as HIV and chronic obstructive pulmonary disease.
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Affiliation(s)
- Angélica Medina
- Programa Nacional de Control de la TuberculosisMinisterio de Salud Pública y Bienestar SocialAsunciónParaguayPrograma Nacional de Control de la Tuberculosis, Ministerio de Salud Pública y Bienestar Social, Asunción, Paraguay.
| | - Lucelly López
- Universidad Pontificia BolivarianaUniversidad Pontificia BolivarianaMedellínColombiaUniversidad Pontificia Bolivariana, Medellín, Colombia.
| | - Celia Martínez
- Facultad de Ciencias MédicasUniversidad Nacional de AsunciónAsunciónParaguayFacultad de Ciencias Médicas, Universidad Nacional de Asunción, Asunción, Paraguay.
| | - Sarita Aguirre
- Programa Nacional de Control de la TuberculosisMinisterio de Salud Pública y Bienestar SocialAsunciónParaguayPrograma Nacional de Control de la Tuberculosis, Ministerio de Salud Pública y Bienestar Social, Asunción, Paraguay.
| | - Edith Alarcón
- Organización Panamericana de la Salud/Organización Mundial de la SaludWashington D.C.Estados Unidos de AméricaOrganización Panamericana de la Salud/Organización Mundial de la Salud, Washington D.C., Estados Unidos de América.
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Long-term all-cause mortality in people treated for tuberculosis: a systematic review and meta-analysis. THE LANCET. INFECTIOUS DISEASES 2019; 19:1129-1137. [DOI: 10.1016/s1473-3099(19)30309-3] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 04/07/2019] [Accepted: 05/03/2019] [Indexed: 11/21/2022]
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Osman M, Welte A, Dunbar R, Brown R, Hoddinott G, Hesseling AC, Marx FM. Morbidity and mortality up to 5 years post tuberculosis treatment in South Africa: A pilot study. Int J Infect Dis 2019; 85:57-63. [PMID: 31132472 DOI: 10.1016/j.ijid.2019.05.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/13/2019] [Accepted: 05/20/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND A high risk of tuberculosis (TB), chronic lung disease, and mortality have been reported among people with a history of previous TB treatment, but data from high-incidence settings remain limited. The aim of this study was to characterize general morbidity and mortality among adults who had successfully completed TB treatment in the past 5 years in a high-incidence setting in South Africa. METHODS Adults (≥18 years) who had completed treatment for pulmonary TB between 2013 and 2017 were randomly selected from TB treatment registers. Household visits were conducted to locate and interview former TB (FTB) patients, and bacteriological testing for TB was offered. Additional data sources were used to ascertain the vitality status of FTB patients who could not be located. RESULTS Addresses were located for 200 of the 223 FTB patients sampled and 89 FTB patients were contacted of whom 51 agreed to be interviewed. Approximately half reported persistent respiratory symptoms, such as shortness of breath and wheezing, and repeated lung infections. One (3.6%) of 28 patients who provided a sputum sample had culture-positive TB and another two were currently on re-treatment for TB. Fifteen deaths post treatment were ascertained, resulting in a standardized mortality ratio of 3.8 (95% confidence interval 2.3-6.3) after successful TB treatment relative to the general population. CONCLUSIONS In this high-incidence setting, locating and interviewing FTB patients was challenging. The study findings are consistent with a high rate of respiratory disease, including recurrent TB, and substantially elevated mortality among FTB patients.
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Affiliation(s)
- Muhammad Osman
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; DST-NRF South African Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa.
| | - Alex Welte
- DST-NRF South African Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| | - Rory Dunbar
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Rosemary Brown
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Anneke C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Florian M Marx
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; DST-NRF South African Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
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Gupte AN, Paradkar M, Selvaraju S, Thiruvengadam K, Shivakumar SVBY, Sekar K, Marinaik S, Momin A, Gaikwad A, Natrajan P, Prithivi M, Shivaramakrishnan G, Pradhan N, Kohli R, Raskar S, Jain D, Velu R, Karthavarayan B, Lokhande R, Suryavanshi N, Gupte N, Murali L, Salvi S, Checkley W, Golub J, Bollinger R, Mave V, Padmapriyadarasini C, Gupta A. Assessment of lung function in successfully treated tuberculosis reveals high burden of ventilatory defects and COPD. PLoS One 2019; 14:e0217289. [PMID: 31120971 PMCID: PMC6532904 DOI: 10.1371/journal.pone.0217289] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 05/08/2019] [Indexed: 12/17/2022] Open
Abstract
Background Burden, phenotype and risk-factors of lung function defects in successfully treated tuberculosis cases are unclear. Methods We performed spirometry with bronchodilators in new drug-sensitive adult (≥18 years) pulmonary tuberculosis cases during the 12 months following successful treatment in India. Airflow obstruction was defined as pre-bronchodilator FEV1/FVC<5th percentile of Global Lung Initiative mixed-ethnicity reference (lower limit of normal [LLN]). Chronic obstructive pulmonary disease (COPD) was defined as post-bronchodilator FEV1/FVC<LLN among participants with obstruction. Restrictive spirometry pattern was defined as FVC<LLN among participants without obstruction. Multivariable logistic and linear regression was used to identify risk-factors for obstruction, restriction and low lung function despite successful treatment. Results Of the 172 participants included in the analysis, 82 (48%) were female, 22 (13%) had diabetes and 34 (20%) ever-smoked with a median (IQR) exposure of 3.5 (0.2–9.9) pack-years. Median (IQR) age and body-mass index (BMI) at enrollment was 32 (23–39) years and 18.1 (16.0–20.5) kg/m2 respectively. Airflow obstruction was detected in 42 (24%) participants; of whom 9 (21%) responded to short-acting bronchodilators and 25 (56%) had COPD; and was associated with duration of illness prior to treatment (aOR = 1.32 per 30-days, 95%CI 1.04–1.68, p = 0.02). A restrictive spirometry pattern was detected in 89 (52%) participants and was associated with female sex (aOR = 3.73, 95%CI 1.51–9.17, p = 0.004) and diabetes (aOR = 4.06, 95%CI 1.14–14.42, p = 0.03). Higher HbA1c at treatment initiation was associated with greater odds of a restrictive spirometry pattern (aOR = 1.29 per unit higher HbA1c, 95%CI 1.04 to 1.60, p = 0.02). Conclusion We found a high burden of lung function defects and COPD in tuberculosis cases who successfully completed treatment. Screening for chronic lung diseases following treatment and linkage to respiratory health clinics should be included in the routine management plan of all tuberculosis cases in India, regardless of conventional COPD risk-factors such as older age and smoking.
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Affiliation(s)
- Akshay N. Gupte
- Johns Hopkins University School of Medicine, Baltimore, United States of America
- * E-mail:
| | - Mandar Paradkar
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | | | | | | | - Krithikaa Sekar
- National Institute for Research in Tuberculosis, Chennai, India
| | | | - Ayesha Momin
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - Archana Gaikwad
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | | | | | | | - Neeta Pradhan
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - Rewa Kohli
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - Swapnil Raskar
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - Divyashri Jain
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - Rani Velu
- National Institute for Research in Tuberculosis, Chennai, India
| | | | - Rahul Lokhande
- Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Pune, India
| | - Nishi Suryavanshi
- Johns Hopkins University School of Medicine, Baltimore, United States of America
| | - Nikhil Gupte
- Johns Hopkins University School of Medicine, Baltimore, United States of America
| | - Lakshmi Murali
- National Institute for Research in Tuberculosis, Chennai, India
| | | | - William Checkley
- Johns Hopkins University School of Medicine, Baltimore, United States of America
| | - Jonathan Golub
- Johns Hopkins University School of Medicine, Baltimore, United States of America
| | - Robert Bollinger
- Johns Hopkins University School of Medicine, Baltimore, United States of America
| | - Vidya Mave
- Johns Hopkins University School of Medicine, Baltimore, United States of America
| | | | - Amita Gupta
- Johns Hopkins University School of Medicine, Baltimore, United States of America
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Aljadani R, Ahmed AE, Al-Jahdali H. Tuberculosis mortality and associated factors at King Abdulaziz Medical City Hospital. BMC Infect Dis 2019; 19:427. [PMID: 31096930 PMCID: PMC6524290 DOI: 10.1186/s12879-019-4063-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 05/02/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) continues to be a public health challenge in Saudi Arabia, particularly for the elderly. This study was conducted to estimate mortality per 1000 person-year among TB and resistant TB cases and to identifying factors associated with mortality. METHODS This is a retrospective cohort study of 713 new TB cases at King Abdulaziz Medical City in Riyadh diagnosed between January 1, 2000, and December 31, 2016. Patient medical records and microbiology lab databases were used to identify TB cases. Through reviews were conducted of patients' medical records, including physician notes, physical examinations, radiology (scans and imaging), laboratory tests, and follow-up notes. Collected data include demographic information, clinical features, diagnoses, comorbidities, and death rates. RESULTS Of the 713 TB patients included in this study, 110 died, giving an average mortality rate of 22 per 1000 person-years (PY; 95% CI: 18.2-26.4). Elderly patients (≥ 60 years) had a higher mortality rate of 36.5 per 1000 PY (95% CI: 28.9-45.5). As age increases by one year, the hazard of mortality increase by 2.4% (aHR: 1.024 [95% CI: 1.009-1.039, P = 0.002]). Higher hazard of mortality was found among males (aHR: 2.014 [95% CI: 1.186-3.418, P = 0.010]). Patients with respiratory and other types of comorbidities and cancer had a higher mortality hazard (aHR: 1.898 [95% CI: 1.005-3.582, P = 0.048]; aHR: 2.346 [95% CI: 1.313-4.192, P = 0.004]; aHR: 3.292 [95% CI: 1.804-6.006, P = 0.001]), respectively. Multidrug-resistant TB (MDR-TB) was found in 2 cases (0.28%) (95% CI: 0.08-1.02), 1.68% were resistant to only one antibiotic, 0.14% had rifampicine-resistant TB (RR-TB), 0.28% had MDR-TB, and 0.14% had extensively drug-resistant TB (XDR-TB). CONCLUSIONS The mortality rate among TB patients was found to be 22 per 1000 person-year at our center. TB was associated with high mortality rates among males, the elderly, and patients with cancer, respiratory illness, and other comorbidities. Future clinical practice should include establishing an efficient TB diagnostic program and continued hazard assessment of TB treatment options.
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Affiliation(s)
| | - Anwar E Ahmed
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Hamdan Al-Jahdali
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia
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Vashakidze SA, Kempker JA, Jakobia NA, Gogishvili SG, Nikolaishvili KA, Goginashvili LM, Magee MJ, Kempker RR. Pulmonary function and respiratory health after successful treatment of drug-resistant tuberculosis. Int J Infect Dis 2019; 82:66-72. [PMID: 30844519 PMCID: PMC6528816 DOI: 10.1016/j.ijid.2019.02.039] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 02/21/2019] [Accepted: 02/24/2019] [Indexed: 12/15/2022] Open
Abstract
Background: Post-treatment morbidity among subjects with drug-resistant tuberculosis (DR-TB) is unclear. Methods: This was a cross-sectional study of patients from Tbilisi, Georgia with cavitary DR-TB and an outcome of cure. Participants had a chest X-ray (CXR), St. George Respiratory Quality (SGRQ) survey, and pulmonary function tests (PFTs) performed. Correlations between SGRQ and PFT results and factors associated with pulmonary impairment were examined. Results: Among 58 subjects (median age 31 years), 40% used tobacco, 59% had prior TB, and 47% underwent adjunctive surgical resection. The median follow-up time was 41 months. Follow-up CXR revealed fibrosis in 30 subjects (52%) and bronchiectasis in seven (12%). The median forced expiratory volume (FEV1)/forced vital capacity (FVC) ratio was 0.72, with 24 subjects (41%) having a ratio of ≤0.70. Significant correlations existed between PFT measures and overall and component SGRQ scores. In linear regression, age, prior TB, and CXR fibrosis or bronchiectasis were significantly associated with decreased pulmonary function. Adjunctive surgery was significantly associated with a higher percent predicted FEV1 and FVC. Conclusions: A high proportion of DR-TB subjects had residual pulmonary impairment, particularly with recurrent TB and severe radiological disease. The association of surgical resection with improved lung function deserves further study. PFTs and SGRQ may both be useful to evaluate lung health.
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Affiliation(s)
| | - Jordan A Kempker
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Nino A Jakobia
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
| | | | | | | | - Matthew J Magee
- Georgia State University, School of Public Health, Atlanta, GA, USA
| | - Russell R Kempker
- Division of Infectious Diseases Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Singh SK, Naaraayan A, Acharya P, Menon B, Bansal V, Jesmajian S. Pulmonary Rehabilitation in Patients with Chronic Lung Impairment from Pulmonary Tuberculosis. Cureus 2018; 10:e3664. [PMID: 30755839 PMCID: PMC6364956 DOI: 10.7759/cureus.3664] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Setting Our study was conducted at a tertiary care center for respiratory illnesses (Viswanathan Chest Hospital, Vallabhbhai Patel Chest Institute (VPCI), University of Delhi, Delhi, India). Patients were enrolled in the study from the outpatient clinic. Objective To assess the effects of pulmonary rehabilitation (PR) in patients with chronic lung impairment from previously treated tuberculosis (CLIPTB), on exercise capacity (six-minute walk distance), pulmonary function tests, quality of life and markers of systemic inflammation. Design Prospective cohort study including 29 patients who had finished anti-tubercular therapy and currently had symptoms of dyspnea with or without cough secondary to CLIPTB. Result Significant improvement in six-minute walk distance (488 meters at baseline vs 526 meters post PR intervention, p-value 0.033) and chronic respiratory questionnaire score (17.21 at baseline vs 18.96 post PR intervention, p-value 0.025) with pulmonary rehabilitation was noted. Pulmonary function tests, inflammatory markers and mid-thigh muscle mass trended towards improvement with pulmonary rehabilitation but were not statistically significant. Conclusion Our study shows that pulmonary rehabilitation is an effective intervention in post-tuberculosis patients and should be recommended.
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Affiliation(s)
- Seema K Singh
- Internal Medicine, Montefiore New Rochelle Hospital, Albert Einstein College of Medicine, New Rochelle, USA
| | - Ashutossh Naaraayan
- Internal Medicine, Montefiore New Rochelle Hospital, Albert Einstein College of Medicine, New Rochelle, USA
| | - Prakash Acharya
- Internal Medicine, Montefiore New Rochelle Hospital, Albert Einstein College of Medicine, New Rochelle, USA
| | - Balakrishnan Menon
- Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, New Delhi, IND
| | - Vishal Bansal
- Physiology, Vallabhbhai Patel Chest Institute, University of Delhi, New Delhi, IND
| | - Stephen Jesmajian
- Internal Medicine, Montefiore New Rochelle Hospital, Albert Einstein College of Medicine, New Rochelle, USA
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KAZEMPOUR DIZAJI M, KAZEMNEJAD A, TABARSI P, ZAYERI F. Risk Factors Associated with Survival of Pulmonary Tuberculosis. IRANIAN JOURNAL OF PUBLIC HEALTH 2018; 47:980-987. [PMID: 30181996 PMCID: PMC6119565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND We conducted this study among adults with pulmonary tuberculosis (TB) who received treatment, in order to determine the risk factors associated with survival of during treatments. METHODS A retrospective cohort study was conducted from 2005-2015 with newly registered TB patients in the Hospital of Masih Daneshvari Doctor, Tehran, Iran. Overall, 5313 patients met our study's cohort definition, but the analysis was performed on 2299 patients (43.2%) who had a correct address and they could be traced-out by the Medical - registry. Time in days was used in survival model and patients who were still alive (until last follow-up date) considered as censored. To study the effect of risk factors on patients' survival, the generalized gamma regression model was used. RESULTS Based on the results of univariate analysis, gender (RR=2 (95% CI: 1.1-3.7), high school education (Relative Risk: RR=0.3 (95% CI: 0.2-0.7), higher education (RR=0.3 (95% CI: 0.1-0.9), smoker (RR=2.5 (95% CI: 1.4-4.2), drug user (RR=2.4 (95% CI: 1.4-4), TB contact (RR=0.5 (95% CI: 0.3-0.8) and HIV positive (RR=4 (95% CI: 1.7-9.2) affected patients' survival. Moreover, the results of multivariate analysis showed that, gender (RR=5.5 (95% CI: 2.2-13.5), age (RR=1.1 (95% CI: 1-1.1), adverse drug effect (RR=2.5 (95% CI: 1.2-5.4), smoker (RR=3.3 (95% CI: 1.2-9.4), TB contact (RR=0.2 (95% CI: 0.1-0.5), diabetic mellitus (RR=3 (95% CI: 1-8.3), HIV positive (RR=26 (95% CI: 4.6-145.9) and comorbidities (RR=4.9 (95% CI: 2-11.6) were identified as factors affecting patients' survival. CONCLUSION Our data indicated associated risk factors in TB mortality and could suggest way to progressing national tuberculosis program (NTP) for predicating and plan for effective interventional strategies.
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Affiliation(s)
- Mehdi KAZEMPOUR DIZAJI
- Dept. of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Anoshirvan KAZEMNEJAD
- Dept. of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran,Corresponding Author:
| | - Payam TABARSI
- Mycobacteriology Research Center, National Research Institute for Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran, Clinical Tuberculosis and Epidemiology Research Center, National Research Institute for Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farid ZAYERI
- Dept. of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Abstract
Rationale: More information on risk factors for death from tuberculosis in the United States could help reduce the tuberculosis mortality rate, which has remained steady for more than a decade.Objective: To identify risk factors for tuberculosis-related death in adults.Methods: We performed a retrospective study of 1,304 adults with tuberculosis who died before treatment completion and 1,039 frequency-matched control subjects who completed tuberculosis treatment in 2005 to 2006 in 13 states reporting 65% of U.S. tuberculosis cases. We used in-depth record abstractions and a standard algorithm to classify deaths in persons with tuberculosis as tuberculosis-related or not. We then compared these classifications to causes of death as coded in death certificates. We used multivariable logistic regression to calculate adjusted odds ratios for predictors of tuberculosis-related death among adults compared with those who completed tuberculosis treatment.Results: Of 1,304 adult deaths, 942 (72%) were tuberculosis related, 272 (21%) were not, and 90 (7%) could not be classified. Of 847 tuberculosis-related deaths with death certificates available, 378 (45%) did not list tuberculosis as a cause of death. Adjusting for known risks, we identified new risks for tuberculosis-related death during treatment: absence of pyrazinamide in the initial regimen (adjusted odds ratio, 3.4; 95% confidence interval, 1.9-6.0); immunosuppressive medications (adjusted odds ratio, 2.5; 95% confidence interval, 1.1-5.6); incomplete tuberculosis diagnostic evaluation (adjusted odds ratio, 2.2; 95% confidence interval, 1.5-3.3), and an alternative nontuberculosis diagnosis before tuberculosis diagnosis (adjusted odds ratio, 1.6; 95% confidence interval, 1.2-2.2).Conclusions: Most persons who died with tuberculosis had a tuberculosis-related death. Intensive record review revealed tuberculosis as a cause of death more often than did death certificate diagnoses. New tools, such as a tuberculosis mortality risk score based on our study findings, may identify patients with tuberculosis for in-hospital interventions to prevent death.
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Stockbridge EL, Miller TL, Carlson EK, Ho C. Private sector tuberculosis prevention in the US: Characteristics associated with interferon-gamma release assay or tuberculin skin testing. PLoS One 2018; 13:e0193432. [PMID: 29590130 PMCID: PMC5873986 DOI: 10.1371/journal.pone.0193432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 02/09/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To determine whether latent tuberculosis infection risk factors are associated with an increased likelihood of latent tuberculosis infection testing in the US private healthcare sector. DATA SOURCE A national sample of medical and pharmacy claims representing services rendered January 2011 through December 2013 for 3,997,986 commercially insured individuals in the US who were 0 to 64 years of age. STUDY DESIGN We used multivariable logistic regression models to determine whether TB/LTBI risk factors were associated with an increased likelihood of Interferon-Gamma Release Assay (IGRA) or Tuberculin Skin Test (TST) testing in the private sector. PRINCIPAL FINDINGS 4.31% (4.27-4.34%) received at least one TST/IGRA test between 2011 and 2013 while 1.69% (1.67-1.72%) received a TST/IGRA test in 2013. Clinical risk factors associated with a significantly increased likelihood of testing included HIV, immunosuppressive therapy, exposure to tuberculosis, a history of tuberculosis, diabetes, tobacco use, end stage renal disease, and alcohol use disorder. Other significant variables included gender, age, asthma, the state tuberculosis rate, population density, and percent of foreign-born persons in a county. CONCLUSIONS Private sector TST/IGRA testing is not uncommon and testing varies with clinical risk indicators. Thus, the private sector can be a powerful resource in the fight against tuberculosis. Analyses of administrative data can inform how best to leverage private sector healthcare toward tuberculosis prevention activities.
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Affiliation(s)
- Erica L. Stockbridge
- Department of Health Behavior and Health Systems, University of North Texas Health Science Center School of Public Health, Fort Worth, TX, United States of America
- Department of Advanced Health Analytics and Solutions, Magellan Health, Inc., Scottsdale, AZ, United States of America
- * E-mail:
| | - Thaddeus L. Miller
- Department of Health Behavior and Health Systems, University of North Texas Health Science Center School of Public Health, Fort Worth, TX, United States of America
| | - Erin K. Carlson
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, United States of America
| | - Christine Ho
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
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van der Werf MJ, Bonfigli S, Hruba F. Will the European Union reach the United Nations Millennium declaration target of a 50% reduction of tuberculosis mortality between 1990 and 2015? BMC Public Health 2017; 17:629. [PMID: 28679426 PMCID: PMC5499048 DOI: 10.1186/s12889-017-4544-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 06/27/2017] [Indexed: 11/10/2022] Open
Abstract
Background The Millennium Development Goals (MDG) provide targets for 2015. MDG 6 includes a target to reduce the tuberculosis (TB) death rate by 50% compared with 1990. We aimed to assess whether this target was reached by the European Union (EU) and European Economic Area countries. Methods We used Eurostat causes of death data to assess whether the target was reached in the EU. We calculated the reduction in reported and adjusted death rates and the annual average percentage decline based on the available data. Results Between 1999 and 2014, the TB death rate decreased by 50%, the adjusted death rate by 56% and the annual average percentage decline was 5.43% (95% confidence interval 4.94–6.74) for the EU. Twenty of 26 countries reporting >5 TB deaths in the first reporting year reached the target of 50% reduction in adjusted death rate. Conclusions The EU reached the MDG target of a 50% reduction of the TB death rate and also the annual average percentage decline was larger than the 2.73% needed to reach the target. The World Health Organization ‘End TB Strategy’ requires a further reduction of the number of TB deaths of 35% by 2020 compared to 2015, which will challenge TB prevention and care services in the EU.
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Fleshner M, Olivier KN, Shaw PA, Adjemian J, Strollo S, Claypool RJ, Folio L, Zelazny A, Holland SM, Prevots DR. Mortality among patients with pulmonary non-tuberculous mycobacteria disease. Int J Tuberc Lung Dis 2017; 20:582-7. [PMID: 27084809 DOI: 10.5588/ijtld.15.0807] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
SETTING Tertiary referral center, National Institutes of Health (NIH), USA. OBJECTIVE To estimate the mortality rate and its correlates among persons with pulmonary non-tuberculous mycobacteria (PNTM) disease. DESIGN A retrospective review of 106 patients who were treated at the NIH Clinical Center and met American Thoracic Society/Infectious Diseases Society of America criteria for PNTM. Eligible patients were aged ⩾18 years and did not have cystic fibrosis or human immunodeficiency virus (HIV) infection. RESULTS Of 106 patients followed for a median of 4.9 years, 27 (25%) died during follow-up, for a mortality rate of 4.2 per 100 person-years. The population was predominantly female (88%) and White (88%), with infrequent comorbidities. Fibrocavitary disease (adjusted hazard ratio [aHR] 3.3, 95% confidence interval [CI] 1.3-8.3) and pulmonary hypertension (aHR 2.1, 95%CI 0.9-5.1) were associated with a significantly elevated risk of mortality in survival analysis. CONCLUSIONS PNTM remains a serious public health concern, with a consistently elevated mortality rate across multiple populations. Significant risk factors for death include fibrocavitary disease and pulmonary hypertension. Further research is needed to more specifically identify clinical and microbiologic factors that jointly influence disease outcome.
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Affiliation(s)
- M Fleshner
- Epidemiology Unit, Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - K N Olivier
- Cardiovascular and Pulmonary Branch, National Heart, Lung and Blood Institute, NIH, Bethesda, Maryland, USA
| | - P A Shaw
- Biostatistics Research Branch, Division of Clinical Research, Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - J Adjemian
- Epidemiology Unit, Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), Bethesda, USA
| | - S Strollo
- Epidemiology Unit, Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), Bethesda, USA
| | - R J Claypool
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), Bethesda, USA
| | - L Folio
- Department of Radiology and Imaging Sciences, Clinical Center, NIH, Bethesda, USA
| | - A Zelazny
- Department of Laboratory Medicine, Clinical Center, NIH, Bethesda, Maryland, USA
| | - S M Holland
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), Bethesda, USA
| | - D R Prevots
- Epidemiology Unit, Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), Bethesda, USA
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Kazempour-Dizaji M, Kazemnejad A, Tabarsi P, Zayeri F. Estimation of Ten-Year Survival of Patients with Pulmonary Tuberculosis Based on the Competing Risks Model in Iran. TANAFFOS 2016; 15:37-43. [PMID: 27403177 PMCID: PMC4937760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Tuberculosis (TB) is a chronic bacterial disease, which despite the presence of effective drug strategies, still remains a serious health problem worldwide. Estimation of survival rate is an appropriate indicator for prognosis in patients with pulmonary TB. Therefore, this research was designed with the aim of accurate estimation of the survival of patients by taking both the death event and relapse into consideration. MATERIALS AND METHODS Based on a retrospective cohort study, information of 2,299 patients with pulmonary TB that had been referred to and treated in Masih Daneshvari Hospital from 2005 to 2015 was reviewed. To estimate the survival of patients with pulmonary TB, the competing risks model, which considered death and relapse as competing events, was used. In addition, the effect of factors affecting the cumulative incidence function (CIF) of death event and relapse was also examined. RESULTS The effect of risk factors on the CIF of death events and relapse showed that patients' age, marital status, contact with TB patients, adverse effect of drugs, imprisonment and HIV positivity were factors that affected the CIF of death. Meanwhile, sex, marital status, imprisonment and HIV positivity were factors affecting the CIF of relapse (P <0.05). Considering death and relapse as competing events, survival estimation in pulmonary TB patients showed that survival in this group of patients in the first, third, fifth and tenth year after treatment was 39%, 14%, 7% and 0%, respectively. CONCLUSION The use of competing risks model in survival analysis of patients with pulmonary TB with consideration of competing events, enables more accurate estimation of survival.
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Affiliation(s)
- Mehdi Kazempour-Dizaji
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Anoshirvan Kazemnejad
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran,,Correspondence to: Kazemnejad A, Address: Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran, Email address:
| | - Payam Tabarsi
- Clinical Tuberculosis and Epidemiology, Research Center, National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farid Zayeri
- Department of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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