Male Sex Is Associated With Worse Microbiological and Clinical Outcomes Following Tuberculosis Treatment: A Retrospective Cohort Study, a Systematic Review of the Literature, and Meta-analysis

Abstract

Background Although the incidence of tuberculosis (TB) is higher in males compared to females, the relationship of sex with TB treatment outcomes has not been adequately studied. Methods We performed a retrospective cohort study and a systematic review and meta-analysis of observational studies during the last 10 years to assess sex differences in clinical and microbiological outcomes in tuberculosis. Results In our cohort of 2,894 patients with drug-susceptible pulmonary TB (1,975 males and 919 females), males had higher adjusted hazards of 9-month mortality due to all causes (HR 1·43,95%CI 1.03-1.98) and infections (HR 1.70, 95%CI 1.09-2.64) and higher adjusted odds ratio for 2-month sputum culture positivity (OR 1.56,95%CI 1.05-2.33) compared to females. Smear positivity at 2 months was not significantly different (OR 1.27, 0.71-2.27) between the sexes. Among 7,896 articles retrieved, 398 articles were included in our systematic review describing a total of 3,957,216 patients. The odds of all-cause mortality were higher in males compared to females in the pooled unadjusted (OR 1.26, 95%CI 1.19-1.34) and adjusted (OR 1.31, 95%CI 1.18-1.45) analyses. Males had higher pooled odds of sputum culture (OR 1.44,95% CI 1.14-1.81) and sputum smear (OR 1.58,95%CI 1.41-1.77) positivity, both at the end of the intensive phase and upon treatment completion. Conclusions Our retrospective cohort showed that male TB patients have higher 9-month all-cause and infection-related mortality, with higher 2-month sputum culture positivity after adjusting for confounding factors. In our meta-analysis, males showed higher all-cause and TB-related mortality and higher sputum culture and smear positivity rates during and after TB treatment.

Age–period–cohort analysis of pulmonary tuberculosis reported incidence, China, 2006–2020

“…Testosterone plays an immunosuppressive and harmful role in the pathogenesis of TB. Adult males are more likely to develop active disease due to smoking, biological or comorbidities [ 33 ], leading to higher mortality [ 34 ].…”

Treatment Outcomes of Childhood Tuberculous Meningitis in a Real-World Retrospective Cohort, Bandung, Indonesia

“…The association of tuberculoma on baseline CT with postdischarge death might be related to a paradoxical worsening of tuberculomas during treatment ( 23 ). For male sex and low-income parents, their associations with in-hospital death are unclear but could be related to biologic factors (particularly for sex differences) or largely attributed to socioeconomic and cultural determinants ( 24 ).…”

Análise comparativa de dados epidemiológicos da Tuberculose em duas cidades metropolitanas da Paraíba (2016-2021)

“…É bem documentado na literatura a maior suscetibilidade masculina à infecção por M. tuberculosis, sendo diversos os estudos que apresentam tal realidade. Uma revisão sistemática de estudos provenientes de 81 países, apontou que homens manifestam as maiores chances de infecção e mortalidade em decorrência da TB (Chidambaram et al, 2021) A presença de fatores como: maior exposição a ambientes de risco, com elevada densidade demográfica; consumo excessivo de álcool e/ou tabagismo; condições de rua, uma vez que homens compreendem cerca de 80% dos moradores de rua; uso de drogas ilícitas; bem como a falta de acesso ou procura por estabelecimentos de saúde, todos influenciam significativamente em uma maior concentração de casos de TB entre os homens (Fernandes et al, 2018;Cortez et al, 2021;Andrade et al, 2021;Sousa et al, 2020;Souza, 2019;Barreto et al, 2020).…”