Incidence and outcome of newly-diagnosed tuberculosis in schizophrenics: a 12-year, nationwide, retrospective longitudinal study

Abstract

BackgroundTo control tuberculosis (TB), it is critical to identify at risk populations. Schizophrenia is recognized as an important risk factor for TB. However, previous studies have been confounded by comorbidities, and reports of TB infection outcomes are rare. Therefore, the current nation-wide study aimed to compare the adjusted incidence and outcome of TB diseases in schizophrenics and the general population.MethodUsing the National Health Insurance Research Database from 1998 to 2009, this retrospective longitudinal study included 60,409 schizophrenics and general population matched for age, Charlson’s score, and comorbidities. Diagnosis of TB was based on the international classification of disease, ninth revision and use of anti-TB drugs. Unfavorable outcome for TB was defined as death, loss to follow-up, or use of anti-TB treatment for more than 9 months.ResultsThe adjusted incidence of TB in schizophrenics was significantly higher than in the general population [hazard ratio, 1.52; 95% confidence interval (CI), 1.29-1.79; p < 0.001; Kaplan-Meier log-rank test, p < 0.001]. Cox regression revealed age and male gender as risk factors for newly-diagnosed TB. The outcome of TB was comparable in schizophrenics and the general population [odds ratio (OR), 0.78; 95% CI, 0.55-1.09; p =0.144]. Logistic regression revealed a statistical trend for diabetes mellitus to predict poor outcome in schizophrenics with TB (OR, 2.30; 95% CI, 0.96-5.74; p = 0.062).ConclusionsSchizophrenics are at increased risk for TB, and screening may be warranted for those living in areas with high prevalence of TB.

Prevalence of tuberculosis among mentally ill patients in conflict-stricken Afghanistan: A cross-sectional study

“…In Korea the risk of TB among patients with depression was more than twice as high as it was among individuals with no mental health problems, and TB incidence was higher for patients with severe depression (Hosseini Divkolaye and Burkle, 2017). In Taiwan, prevalence of TB was 1.6 times higher in patients with mental health disorders, and another study found that the incidence of risk of TB in schizophrenic patients was 1.52 times higher than in those without mental illness (Kuo et al, 2013).…”

Is 1-year follow-up adequate for adult tuberculosis contacts?

“…Yet, retreatment tuberculosis (TB) suspects have been infrequently included in studies of Xpert [4], probably because current-generation PCR-based tests are unable to determine Mycobacterium tuberculosis viability [5]. Indeed, Xpert is known to frequently remain positive at the end of standard short-course therapy [6], with case reports emerging of Xpert false-positivity for up to 5 years post-treatment completion [7,8]. Furthermore, 56% (n=3485/6285) of specificity data informing the most recent Cochrane meta-analysis [4] was derived from validation and demonstration studies [9,10], which may be optimistic due to selection bias related to post-enrolment exclusions [7].…”

“…We also matched each TB contact with four nonexposed subjects by age and sex, and presence of comorbidities on the same index date of diagnosis. The TB contacts cohort and the matched cohort were followed until the development of active TB disease, which was defined by compatible ICD-9-CM codes (010-018 in ICD-9-CM) [6,7]. The diagnosis of TB was validated by the prescription of at least two anti-TB medications for more than 28 days.…”

Acquired Factor XII Deficiency in a Patient with Schizophrenia

“…These findings trigger questions regarding what disorders can be result following the schizophrenia-induced autoimmunity. Previous studies showed that the incidence rate of tuberculosis is remarkably higher in schizophrenic patients than that of the general population [8]. In fact, schizophrenia has been considered as an important risk factor for tuberculosis.…”