Differences between Risk Factors Associated with Tuberculosis Treatment Abandonment and Mortality

Abstract

Objectives. To identify the risk factors that were associated with abandonment of treatment and mortality in tuberculosis (TB) patients. Methods. This study was a retrospective longitudinal cohort study involving tuberculosis patients treated between 2002 and 2008 in a TB reference center. Results. A total of 1,257 patients were evaluated, with 69.1% men, 54.4% under 40 years of age, 18.9% with extrapulmonary disease, and 9.3% coinfected with HIV. The risk factors that were associated with abandonment of treatment included male gender (OR = 2.05; 95% CI = 1.15–3.65) and nonadherence to previous treatment (OR = 3.14; 95% CI = 1.96–5.96). In addition, the presence of extrapulmonary TB was a protective factor (OR = 0.33, 95% CI = 0.14–0.76). The following risk factors were associated with mortality: age over 40 years (OR = 2.61, 95% CI = 1.76–3.85), coinfection with HIV (OR = 6.01, 95% CI = 3.78–9.56), illiteracy (OR = 1.88, 95% CI = 1.27–2.75), the presence of severe extrapulmonary TB (OR = 2.33, 95% CI = 1.24–4.38), and retreatment after relapse (OR = 1.95, 95% CI = 1.01–3.75). Conclusions. Male gender and retreatment after abandonment were independent risk factors for nonadherence to TB treatment. Furthermore, age over 40 years, coinfection with HIV, illiteracy, severe extrapulmonary TB, and retreatment after relapse were associated with higher TB mortality. Therefore, we suggest the implementation of direct measures that will control the identified risk factors to reduce the rates of treatment failure and TB-associated mortality.

30 Years Retrospective Review of Tuberculosis Cases in a Tuberculosis Dispensary in Bursa/Nilufer, Turkey (1985-2014)

“…In the study by Özkara et al in 108 dispensaries, the rate of extrapulmonary TB was reported to vary between 14.8% and 28.4% between provinces 34. In this study, although the rate of extrapulmonary TB was significantly lower in males, relapse cases and patients with a history of contact in the last decade, it was significantly higher in females14,35,36 and those younger than 15 years35 and most frequently showed pleura and lymph node involvement,30,37 similar to some domestic and foreign studies. In studies carried out in the United States and Brazil, drug resistance was reported to be low in extrapulmonary TB patients 30,36.…”

“…In this study, although the rate of extrapulmonary TB was significantly lower in males, relapse cases and patients with a history of contact in the last decade, it was significantly higher in females14,35,36 and those younger than 15 years35 and most frequently showed pleura and lymph node involvement,30,37 similar to some domestic and foreign studies. In studies carried out in the United States and Brazil, drug resistance was reported to be low in extrapulmonary TB patients 30,36. Extrapulmonary tuberculosis can be affected by comorbidities that cause immunodeficiency, such as HIV infection; patient characteristics; endocrine factors; immunological and genetic susceptibilities; and differences in endemic tuberculosis strains by population and geographical region, and these factors should be identified 30,35,36.…”

“…A study carried out in Brazil found that being over the age of 40 years, concomitant HIV infection, illiteracy, severe extrapulmonary TB and re-treatment after relapse were risk factors associated with mortality 30. In this study, all of the 26 observed deaths occurred in patients aged 40 years and older.…”

“…In a study carried out in Brazil, the relapse rate was reported as 5.5% and was associated with high mortality 30. This study had a lower percentage of new cases than other studies, but a higher relapse rate 14,29.…”

“…In studies carried out in the United States and Brazil, drug resistance was reported to be low in extrapulmonary TB patients 30,36. Extrapulmonary tuberculosis can be affected by comorbidities that cause immunodeficiency, such as HIV infection; patient characteristics; endocrine factors; immunological and genetic susceptibilities; and differences in endemic tuberculosis strains by population and geographical region, and these factors should be identified 30,35,36. Extrapulmonary tuberculosis had different epidemiological characteristics and risk factors from pulmonary tuberculosis; it can become infectious if it spreads to the lungs, but it is otherwise not infective.…”