1352. The Burden of Active Tuberculosis in an Integrated Healthcare System, 1997–2016: Incidence, Mortality, and Excess Healthcare Utilization

Abstract

BackgroundActive tuberculosis (TB) often results from reactivation of latent tuberculosis infection (LTBI). This can be prevented through LTBI screening and treatment, yet only 12% of Californians have undergone LTBI therapy. Updated estimates on the complete burden of active TB are needed to rationally allocate resources for LTBI program implementation.MethodsWe identified all patients with microbiologically confirmed active TB in a large, integrated health system (Kaiser Permanente Northern California, or KPNC) from 1997 to 2016. We calculated active TB incidence in KPNC and measured this against California’s reported cases. Within KPNC, we compared mortality, hospital, emergency department, and ambulatory care use among persons with active TB to age-, sex-, and year-of-diagnosis-matched cohort of persons without active TB.ResultsActive TB incidence was lower in KPNC (3.4/100,000 person-years) than in California (7.2/100,000 person-years). Among 2,522 active TB cases, early and delayed mortality was high with 7.0% dying within 1 year of diagnosis and 6.2% dying 1–5 years post-diagnosis. Of the 1,957 active TB patients who continued to receive care through KPNC for at least one year post-diagnosis, 603 (30.8%) had at least one hospitalization. In KPNC, active TB patients had higher healthcare utilization than the matched cohort in the one year following diagnosis: 0.6 vs. 0.1 hospitalizations, 9.5 vs. 4.6 days mean length-of-stay, 0.8 vs. 0.3 emergency department visits, and 14.6 vs. 5.9 ambulatory visits.ConclusionPatients with active TB disease have substantial mortality and high inpatient and outpatient healthcare utilization. By improving LTBI screening and treatment, large healthcare systems may be able to reduce the burden and costs associated with active TB.Disclosures All authors: No reported disclosures.