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Zarembaitė G, Žiūkaitė G, Chmieliauskas S, Vasiljevaitė D, Laima S, Stasiūnienė J. Tuberculosis and Sudden Death in Lithuania. Acta Med Litu 2023; 30:152-162. [PMID: 38516517 PMCID: PMC10952429 DOI: 10.15388/amed.2023.30.2.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/10/2023] [Accepted: 05/16/2023] [Indexed: 03/23/2024] Open
Abstract
Background Tuberculosis is one of the most common infectious diseases in the world. 10.6 million people fell ill in 2021 and 1.6 million died from the disease. Lithuania has the third-highest tuberculosis incidence rate per 100,000 and the second-highest mortality rate per 100,000 in EU/EEA countries. During 2015-2021 years, there were 799 deaths of pulmonary tuberculosis in Lithuania. However, the presence of pulmonary tuberculosis is often unknown before death and is only revealed during autopsy. The aim of the study is to review current literature on this topic and present statistical analysis on evaluated socioeconomical, epidemiological indicators, as well as autopsy findings that may suggest pulmonary tuberculosis infection. Materials and methods This research was designed as a retrospective study focusing on full forensic pathology autopsies between 2015 and 2021. Of these, 100 cases were randomly selected where the cause of death was tuberculosis diagnosed during post-mortem examination and compared to a control group consisting of 415 cases of sudden death. Results The study revealed that out of 100 pulmonary tuberculosis cases, 90% were male with the mean age of 53.48 ± 11.12 years old. In the case of sudden death where tuberculosis was found, a significant portion of the sample (91%) was not followed up at any medical institution. Regarding socioeconomic factors, a moderate negative correlation between Lithuania's gross domestic product and tuberculosis distribution was observed, as well as a weak negative correlation between alcohol consumption (l per capita) in the general population and tuberculosis distribution. The lung weight of the pulmonary tuberculosis group was statistically significantly higher than that of the control group. Conclusions Tuberculosis remains a major problem in Lithuania and the combination of socioeconomic indicators determines the prevalence of tuberculosis in the country. In cases of sudden death, autopsy helps to identify tuberculosis cases that have not been clinically detected and ensures tuberculosis monitoring. Therefore, the person who performs autopsy remains at high risk of contracting tuberculosis. Furthermore, extreme caution is advised if higher lung weight or hardenings are seen during autopsy because of the possibility of tuberculosis.
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Affiliation(s)
| | | | - Sigitas Chmieliauskas
- Department of Pathology, Forensic Medicine and Pharmacology, Institute of Biomedical Sciences of the Faculty of Medicine of Vilnius University, Vilnius, Lithuania
| | - Diana Vasiljevaitė
- Department of Pathology, Forensic Medicine and Pharmacology, Institute of Biomedical Sciences of the Faculty of Medicine of Vilnius University, Vilnius, Lithuania
| | - Sigitas Laima
- Department of Pathology, Forensic Medicine and Pharmacology, Institute of Biomedical Sciences of the Faculty of Medicine of Vilnius University, Vilnius, Lithuania
| | - Jurgita Stasiūnienė
- Department of Pathology, Forensic Medicine and Pharmacology, Institute of Biomedical Sciences of the Faculty of Medicine of Vilnius University, Vilnius, Lithuania
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Nordholm AC, Andersen AB, Wejse C, Norman A, Ekstrøm CT, Andersen PH, Lillebaek T, Koch A. Mortality, risk factors, and causes of death among people with tuberculosis in Denmark, 1990-2018. Int J Infect Dis 2023; 130:76-82. [PMID: 36907546 DOI: 10.1016/j.ijid.2023.02.024] [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: 12/21/2022] [Revised: 02/27/2023] [Accepted: 02/27/2023] [Indexed: 03/12/2023] Open
Abstract
OBJECTIVES This study aimed to analyze mortality, risk factors, and causes of death among people with tuberculosis (TB). METHODS This is a population-based cohort study with patients with TB ≥18 years notified from 1990 to 2018 in Denmark, compared with sex- and age-matched controls. Mortality was assessed in Kaplan-Meier models and risk factors for death were estimated in Cox proportional hazards models. RESULTS Overall mortality was twofold higher among people with TB compared with controls up to 15 years after TB diagnosis (hazard ratio [HR]: 2.18, 95% confidence interval [CI]: 2.06-2.29, P <0.0001). Danes with TB were three times more likely to die than migrants (adjusted HR: 3.13, 95% CI: 2.84-3.45, P <0.0001). Risk factors for death included living alone, being unemployed, having low income, and comorbidities such as mental illness with substance abuse, lung diseases, hepatitis, and HIV. TB was the most common cause of death (21%), followed by chronic obstructive pulmonary disease (7%), lung cancer (6%), alcoholic liver disease (5%), and mental illness with substance abuse (4%). CONCLUSION People with TB had substantially inferior survival up to 15 years after TB diagnosis, in particular, socially disadvantaged Danes with TB with specific comorbidities. This may reflect unmet needs for enhanced treatment of other medical/social conditions during TB treatment.
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Affiliation(s)
- Anne Christine Nordholm
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark.
| | - Aase Bengaard Andersen
- Department of Infectious Diseases, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian Wejse
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark; Center for Global Health, Aarhus University, Aarhus, Denmark
| | - Anders Norman
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark
| | - Claus Thorn Ekstrøm
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Peter Henrik Andersen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Troels Lillebaek
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark; Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anders Koch
- Department of Infectious Diseases, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark; Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
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3
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Valencia-Aguirre S, Arroyave I, García-Basteiro AL. Educational level and tuberculosis mortality in Colombia: growing inequalities and stagnation in reduction. CAD SAUDE PUBLICA 2022; 38:e00031721. [PMID: 35107505 DOI: 10.1590/0102-311x00031721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 07/16/2021] [Indexed: 11/22/2022] Open
Abstract
We aim to describe the role of educational inequalities, for sex and age groups, in adult tuberculosis (TB) mortality in Colombia, 1999-2017. We linked mortality data to data estimation of the national population based on censuses and surveys to obtain primary, secondary, and tertiary adult (25+ years of age) age-standardized mortality rates (ASMR) by educational level. Thus, a population-based study was conducted using national secondary mortality data between 1999 and 2017. Tuberculosis age-standardized mortality rates were calculated separately by educational level, sex, and age groups, using Poisson regression models. Educational relative inequalities in adult mortality were evaluated by calculating the rate ratio, and the relative index of inequality (RII). Trends and joinpoints were evaluated by annual percentage change (APC). We found that, out of the 19,720 TB deaths reported, 69% occurred in men, and 45% in older adults (men and women, aged 65+). Men presented higher TB mortality rates than women (ASMR men = 7.1/100,000 inhabitants, ASMR women = 2.7/100,000 inhabitants). As mortality was consistently higher in the lowest educational level for both sexes and all age groups, inequalities in TB mortality were found to be high (RII = 9.7 and 13.4 among men and women, respectively) and growing at an annual rate of 8% and 1%. High and increasing inequalities, regarding educational level, in TB mortality in Colombia suggest the need to comprehensively address strategies for reducing TB by considering social determinants and including health education strategies throughout the country.
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Affiliation(s)
| | - Ivan Arroyave
- Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia
| | - Alberto L García-Basteiro
- Centro de Investigação em Saúde de Manhiça, Maputo, Moçambique.,Institut de Salut Global de Barcelona, Universitat de Barcelona, Barcelona, España
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Pedrazzoli D, Kranzer K, Thomas HL, Lalor MK. Trends and risk factors for death and excess all-cause mortality among notified tuberculosis patients in the UK: an analysis of surveillance data. ERJ Open Res 2019; 5:00125-2019. [PMID: 31857993 PMCID: PMC6911924 DOI: 10.1183/23120541.00125-2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 09/24/2019] [Indexed: 11/05/2022] Open
Abstract
Introduction In the UK, several hundred patients notified with tuberculosis (TB) die every year. The aim of this article is to describe trends in deaths among notified TB patients, explore risk factors associated with death and compare all-cause mortality in TB patients with age-specific mortality rates in the general UK population. Methods We used 2001–2014 data from UK national TB surveillance to explore trends and risk factors for death, and population mortality data to compare age-specific death rates among notified TB patients with annual death rates in the UK general population. Results The proportion of TB patients in the UK who died each year declined steadily from 7.1% in 2002 to 5.5% in 2014. One in five patients (21.3%) was diagnosed with TB post-mortem. Where information was available, almost half of the deaths occurred within 2 months of starting treatment. Risk factors for death included demographic, disease-specific and social risk factors. Age had by far the largest effect, with patients aged ≥80 years having a 70 times increased risk of death compared with those aged <15 years. In contrast, excess mortality determined by incidence ratios comparing all-cause mortality among TB patients with that of the general population was highest among children and the working-age population (15–64 years old). Conclusions Efforts to control TB and improve diagnosis and treatment outcomes in the UK need to be sustained. Control efforts need to focus on socially deprived and vulnerable groups. There is a need for further in-depth analysis of deaths of TB patients in the UK to identify potentially preventable factors. Despite an overall decline in death among TB patients in the UK, patients with TB are still 6 times more likely to die during follow-up than the annual death rate in the general populationhttp://bit.ly/2MqDw9Q
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Affiliation(s)
- Debora Pedrazzoli
- Dept of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.,These authors contributed equally to this work
| | - Katharina Kranzer
- Dept of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK.,These authors contributed equally to this work
| | - H Lucy Thomas
- TB Unit, Tuberculosis, Acute Respiratory, Gastrointestinal, Emerging/Zoonotic Infections and Travel Migrant Health Division (TARGETS), National Infection Service, Public Health England, London, UK
| | - Maeve K Lalor
- TB Unit, Tuberculosis, Acute Respiratory, Gastrointestinal, Emerging/Zoonotic Infections and Travel Migrant Health Division (TARGETS), National Infection Service, Public Health England, London, UK.,Institute for Global Health, University College London, London, UK
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5
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Fløe A, Hilberg O, Wejse C, Ibsen R, Løkke A. Comorbidities, mortality and causes of death among patients with tuberculosis in Denmark 1998-2010: a nationwide, register-based case-control study. Thorax 2017; 73:70-77. [PMID: 28778918 DOI: 10.1136/thoraxjnl-2016-209240] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 05/19/2017] [Accepted: 07/10/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate the impact of comorbidities, age and clinical presentation of TB on mortality among Danish patients with TB. METHODS Danish patients with an ICD-10 (International Statistical Classification of Diseases and Related Health Problems 10th Revision) diagnosis of TB in 1998-2010 were identified in the National Patient Registry and matched with controls (1:4) on age, gender, civil status and geography. Comorbid diagnoses up to 3 years before and after TB diagnosis or enrolment as control as well as survival data were obtained from national databases RESULTS: We included 8433 cases and 33 707 controls. Respiratory diseases were the most common comorbidities among cases (12.4% of cases, 3.8% of controls (p<0.001)). Overall HR of death was 2.45 (2.31; 2.59). Relative mortality was especially increased among younger adults (HR 8.70 (95% CI 5.53 to 13.69) among the 30 to 39-year-olds). While overall mortality increased with Deyo-Charlson comorbidity (DCC) score, relative mortality among cases was highest in the low-DCC group. Additionally, male gender, low income and central nervous system TB were risk factors for death among TB cases. The most common cause of death in both groups was non-lung cancers, among TB cases followed by COPD, TB and lung cancer, all being significantly more common among TB cases. CONCLUSION In Denmark, TB carries substantial mortality. Among those who die, 12% are reported to die from TB. A high relative mortality among younger adults underscores the importance of continually targeting high-risk TB groups in low-incidence countries.
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Affiliation(s)
- Andreas Fløe
- Department of Respiratory Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Ole Hilberg
- Department of Respiratory Diseases, Sygehus Lillebaelt, Vejle, Denmark
| | - Christian Wejse
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark.,Department of Public Health, Center for Global Health, Aarhus University, Aarhus, Denmark
| | | | - Anders Løkke
- Department of Respiratory Diseases, Aarhus University Hospital, Aarhus, Denmark
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Al-Rahamneh MJ, Al-Rahamneh A, Guillén-Grima F, Arnedo-Pena A, Aguinaga-Ontoso I. Mortality trends for tuberculosis in European Union countries, 2000-2010. Enferm Infecc Microbiol Clin 2017; 36:342-351. [PMID: 28733107 DOI: 10.1016/j.eimc.2017.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 05/03/2017] [Accepted: 05/26/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The objective of this study was to update and analyze tuberculosis (TB) mortality data in the European Union between 2000 and 2010 separately for men and women and try to detect if there have been any changes in trends in each country and the association with the economic situation and inequalities. METHODS Data were extracted for tuberculosis deaths in 2000-2010 for 29 European Union countries and for Switzerland, via the World Health Organization (WHO) European detailed mortality database (DMDB), using the Mortality tabulation list 1 (MTL1) codes for men and women separately for one age group (20-85+). We estimated age-standardised mortality rates, and analyzed data using the Joinpoint Regression Program for men and women separately in the European Union overall and by individual country for each year. RESULTS Between 2000 and 2010, there were 68,771 recorded tuberculosis deaths in the European Union and the mortality rates were higher for men than women in the entire study zone. Overall, TB mortality rates declined linearly for both genders, but more in women than in men (from 5.43/100,000 in 2000 to 2.59/100,000 in 2010 in men and from 1.37/100,000 in 2000 to 0.51/100,000 in 2010 in women). There was decline in both genders for the entire study period, with a significant Estimated Annual Percentage Change (EAPC) of -8.1 for women and -7 for men when alpha<0.05 and with a 95% confidence interval (CI). A higher tuberculosis mortality was associated with lower economic resources and greater inequalities. CONCLUSIONS TB mortality rates in the European Union decreased overall in 2000-2010 for both genders. Men have higher TB mortality rates than women in all countries. Our findings were consistent with the downward TB mortality trend in many other countries worldwide.
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Affiliation(s)
- Moad J Al-Rahamneh
- Public University of Navarra, Department of Health Sciences, Avda. Barañain s/n, Pamplona, Navarra 31008, Spain.
| | - Anas Al-Rahamneh
- Citius-Center for Research on Information Technologies, Santiago de Compostela, A Coruña, Spain
| | - Francisco Guillén-Grima
- Public University of Navarra, Department of Health Sciences, Avda. Barañain s/n, Pamplona, Navarra 31008, Spain; Clínica Universitaria de Navarra, Department of Preventive Medicine, Pamplona, Navarra, Spain; Servicio Navarro de Salud-Osasunbidea-IdiSNA, Navarra Institute for Health Research, 31002 Pamplona, Spain
| | - Alberto Arnedo-Pena
- Public University of Navarra, Department of Health Sciences, Avda. Barañain s/n, Pamplona, Navarra 31008, Spain
| | - Inés Aguinaga-Ontoso
- Public University of Navarra, Department of Health Sciences, Avda. Barañain s/n, Pamplona, Navarra 31008, Spain
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7
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Mackenbach JP, Bopp M, Deboosere P, Kovacs K, Leinsalu M, Martikainen P, Menvielle G, Regidor E, de Gelder R. Determinants of the magnitude of socioeconomic inequalities in mortality: A study of 17 European countries. Health Place 2017; 47:44-53. [PMID: 28738213 DOI: 10.1016/j.healthplace.2017.07.005] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 06/24/2017] [Accepted: 07/18/2017] [Indexed: 11/24/2022]
Abstract
The magnitude of socioeconomic inequalities in mortality differs importantly between countries, but these variations have not been satisfactorily explained. We explored the role of behavioral and structural determinants of these variations, by using a dataset covering 17 European countries in the period 1970-2010, and by conducting multilevel multivariate regression analyses. Our results suggest that between-country variations in inequalities in current mortality can partly be understood from variations in inequalities in smoking, excessive alcohol consumption, and poverty. Also, countries with higher national income, higher quality of government, higher social transfers, higher health care expenditure and more self-expression values have smaller inequalities in mortality. Finally, trends in behavioral risk factors, particularly smoking and excessive alcohol consumption, appear to partly explain variations in inequalities in mortality trends. This study shows that analyses of variations in health inequalities between countries can help to identify entry-points for policy.
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Affiliation(s)
- Johan P Mackenbach
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, Netherlands.
| | - Matthias Bopp
- Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
| | - Patrick Deboosere
- Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Katalin Kovacs
- Demographic Research Institute of the Central Statistical Office, Budapest, Hungary
| | - Mall Leinsalu
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia; Stockholm Centre for Health and Social Change, Södertörn University, Huddinge, Sweden
| | | | - Gwenn Menvielle
- Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Sorbonne Universités, UPMC Univ Paris 06, INSERM, Paris, France
| | - Enrique Regidor
- Department of Preventive Medicine and Public Health, Universidad Complutense de Madrid, Madrid, Spain
| | - Rianne de Gelder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, Netherlands
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Adzic-Vukicevic T, Barac A, Ilic AD, Jankovic R, Hadzi-Djokic J, Pesut D. First reported case of fulminant TB with progression of infection from lungs to the genitourinary region. Rev Inst Med Trop Sao Paulo 2017; 59:e20. [PMID: 28423095 PMCID: PMC5440999 DOI: 10.1590/s1678-9946201759020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 02/22/2017] [Indexed: 12/03/2022] Open
Abstract
Although tuberculosis (TB) is a curable disease, it continues to be one of the
leading infections associated with death in the world. Extra-pulmonary TB (EPTB)
occurs in approximately 10% of the total cases, presenting with lymph nodes, pleura,
bone and genitourinary tract as the most common locations. Genitourinary
tuberculosis, the second most common EPTB, is very difficult to diagnose unless there
is a high index of suspicion. Isolated TB orchitis or prostatitis without clinical
evidence of renal involvement is a rare entity among genitourinary tuberculosis. We
presented the first reported case of TB prostatitis and orchitis associated with
pulmonary TB and the presence of an acute massive caseous pneumonia in an
immunocompetent man. Despite the anti-TB therapy, the patient presented a rapid
progression of disease and deterioration of general conditions taking to death, which
occurred four days after TB treatment had started. Disseminated TB is a relatively
uncommon cause of acute massive caseous pneumonia; however, there should always be
suspicion of the disease, since it is a potentially treatable cause. This rare case
supports the assertion that TB should be considered as an important differential
diagnosis of genitourinary tumors irrespective of evidence of active TB elsewhere in
the body.
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Affiliation(s)
- Tatjana Adzic-Vukicevic
- University of Belgrade, School of Medicine, Belgrade, Serbia.,Clinical Centre of Serbia, Clinic for Pulmonology, Belgrade, Serbia
| | - Aleksandra Barac
- Clinical Centre of Serbia, Clinic for Infectious and Tropic Diseases, Belgrade, Serbia
| | - Aleksandra Dudvarski Ilic
- University of Belgrade, School of Medicine, Belgrade, Serbia.,Clinical Centre of Serbia, Clinic for Pulmonology, Belgrade, Serbia
| | - Radmila Jankovic
- University of Belgrade, School of Medicine, Institute for Pathology, Belgrade, Serbia
| | | | - Dragica Pesut
- University of Belgrade, School of Medicine, Belgrade, Serbia.,Clinical Centre of Serbia, Clinic for Pulmonology, Belgrade, Serbia
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