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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: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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