Comorbidities, mortality and causes of death among patients with tuberculosis in Denmark 1998–2010: a nationwide, register-based case–control study

Fløe, Andreas; Hilberg, Ole; Wejse, Christian; Ibsen, Rikke; Løkke, Anders

doi:10.1136/thoraxjnl-2016-209240

Cited by 33 publications

(22 citation statements)

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“…We found a striking difference between Finnish-born cases and those with foreign origins: over one-fifth of Finnish-born cases versus less than 2 % of those with foreign origins had death as outcome, but origin was not independently associated with death in multivariable analysis. Male gender was a risk factor for death as outcome, consistent with our earlier study in Finland [28] as well as previous reports from other low-incidence countries [3,7,29]. We were not able to evaluate reasons for the large risk difference between genders particularly at young age groups, because we did not have data on several risk factors, such as alcohol and substance abuse, the use of immunosuppressive medications and the implementation of directly observed therapy (DOT).…”

Section: Discussionsupporting

confidence: 78%

“…The majority of TB among the Finnish-born population is in the elderly persons from reactivation of a latent TB infection, reflected by the mean age of 71 years among Finnish-born TB cases in 2017, the highest in the EU/EEA countries [1]. In countries with a high proportion of elderly cases, comorbidities are common, probably contributing to higher mortality observed in TB outcome monitoring [7] and complicating the interpretation of treatment non-success rates between countries.…”

Section: Introductionmentioning

confidence: 99%

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Risk factors affecting treatment outcomes for pulmonary tuberculosis in Finland 2007–2014: a national cohort study

et al. 2020

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Background: Major transition in tuberculosis (TB) epidemiology is taking place in many European countries including Finland. Monitoring treatment outcome of TB cases is important for identifying gaps in the national TB control program, in order to strengthen the system. The aim of the study was to identify potential risk factors for non-successful TB treatment outcomes, with a particular focus on the impact of comorbidities. We also evaluated the treatment outcome monitoring system. Methods: All notified microbiologically confirmed pulmonary TB cases in Finland in 2007-2014 were included, except multi-drug resistant (MDR) cases. Nationwide register data were retrieved from: Infectious Diseases Register, Population Register, Cause of Death Register and Hospital Discharge Register. Non-successful outcomes were divided into three groups: death, unsatisfactory outcomes and non-defined outcomes. Logistic regression analyses were used to identify risk factors for non-successful outcomes. Results: Treatment outcomes were notified for 98.6% of study cases (n = 1396/1416). Treatment success rate was 75%. The main reason for non-successful outcome was death (16%), whereas outcomes failed and lost to follow-up were rare (1% together). In a multivariable model, risk factors for death as outcome were increasing age, male gender and Charlson comorbidity index ≥1, for unsatisfactory outcomes non-MDR drug resistance and TB registered in the first study period, and for non-defined outcomes non-MDR drug resistance. Among 50 cases with unsatisfactory outcomes, we observed false outcome allocations in eight (16%), and > 2% of the cases transferred to another country or disappeared before or during treatment. Conclusions: With a high proportion of older population among tuberculosis cases, death is a common treatment outcome in Finland. Comorbidity is an important factor to be incorporated when interpreting and comparing outcome rates. There was a considerable inconsistency in outcome allocation in the monitoring system, which implies that there is need to review the guidelines and provide further training for outcome assessment.

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Section: Discussionsupporting

confidence: 78%

Section: Introductionmentioning

confidence: 99%

Risk factors affecting treatment outcomes for pulmonary tuberculosis in Finland 2007–2014: a national cohort study

et al. 2020

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“…Nevertheless, there is still a number of people who die before or while on TB treatment. Earlier Danish studies have demonstrated increased long term mortality in TB patients, and a recent Danish study, found the overall hazard ratio of death was 2.45 during two year follow up [2,3]. The study identified increasing age and increasing number of comorbidities to be associated with mortality.…”

Section: Introductionmentioning

confidence: 69%

Characteristics and predictors for tuberculosis related mortality in Denmark from 2009 through 2014: A retrospective cohort study

et al. 2020

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“…and demographic (low access to health system and food safety, unemployment, precarious housing, etc.) characteristics on the outcome [19][20][21]. Public health and social policies as income distribution are measures that could impact these factors and TB mortality.…”

Section: Table 2 Distribution Of Associated Causes On Death Certificmentioning

confidence: 99%

Social, demographic, health care and co-morbidity predictors of tuberculosis mortality in Amazonas, Brazil: a multiple cause of death approach

et al. 2020

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Comorbidities, mortality and causes of death among patients with tuberculosis in Denmark 1998–2010: a nationwide, register-based case–control study

Abstract: 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.

Cited by 33 publications

References 33 publications

Risk factors affecting treatment outcomes for pulmonary tuberculosis in Finland 2007–2014: a national cohort study

Risk factors affecting treatment outcomes for pulmonary tuberculosis in Finland 2007–2014: a national cohort study

Characteristics and predictors for tuberculosis related mortality in Denmark from 2009 through 2014: A retrospective cohort study

Social, demographic, health care and co-morbidity predictors of tuberculosis mortality in Amazonas, Brazil: a multiple cause of death approach

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