Mortality Hazard and Survival After Tuberculosis Treatment

Abstract

Objectives We compared mortality among tuberculosis (TB) survivors and a similar population. Methods We used local health authority records from3 US sites to identify 3853 persons who completed adequate treatment of TB and 7282 individuals diagnosed with latent TB infection 1993 to 2002. We then retrospectively observed mortality after 6 to 16 years of observation. We ascertained vital status as of December 31, 2008, using the Centers for Disease Control and Prevention’s National Death Index. We analyzed mortality rates, hazards, and associations using Cox regression. Results We traced 11 135 individuals over 119 772 person-years of observation. We found more all-cause deaths (20.7% vs 3.1%) among posttreatment TB patients than among the comparison group, an adjusted average excess of 7.6 deaths per 1000 person-years (8.8 vs 1.2; P < .001). Mortality among posttreatment TB patients varied with observable factors such as race, site of disease, HIV status, and birth country. Conclusions Fully treated TB is still associated with substantial mortality risk. Cure as currently understood may be insufficient protection against TB-associated mortality in the years after treatment, and TB prevention may be a valuable opportunity to modify this risk.

In reply

“…1 Asthma and coexistent TB predispose to clinical manifestations, including pneumonia, bronchiectasis and pulmonary abscesses. 3,5 We report here the first case from India.…”

“…3 We have found health outcomes for populations with either a history of active TB or LTBI to be consistently dissimilar to those of the general US population in our other analyses as well. 4,5 We are confident that our adjusted model reliably captures the burden of excess mortality associated with a history of fully treated TB in the US. More importantly, we believe that research to identify and explain causal factors related to this phenomenon may lead to strategies that can reduce this burden.…”

“…[2][3][4][5] House dust contaminated with cysts may be inhaled, initiating infection. Infections are reported mostly in adults; very few have been described in children.…”

Who were the tuberculosis patients who died precociously due to the disease in Southern Brazil? A retrospective cohort study

“…As well as being the most common clinical form, it is also the most relevant, as this is a transmittable form of the disease. A study found that individuals with the pulmonary form had a longer survival period than those with the extrapulmonary form of the disease [30].…”

Private sector tuberculosis prevention in the US: Characteristics associated with interferon-gamma release assay or tuberculin skin testing

“…Although TB is less prevalent in the US than in many other countries, nearly 10,000 new TB cases are diagnosed in the US annually [ 2 – 4 ]. TB is a debilitating and potentially deadly illness with long-term health consequences and substantially increased mortality risk even after treatment is completed [ 5 , 6 ]. Further, TB in the US exacts great financial and societal costs [ 5 , 7 , 8 ].…”