Post-treatment Mortality Among Patients With Tuberculosis: A Prospective Cohort Study of 10 964 Patients in Vietnam

Fox, Greg J.; Nguyen, Viet Nhung; Dinh, Ngoc Sy; Nghiem, Le Phuong Hoa; Le, Thi Ngoc Anh; Nguyen, Thu Anh; Nguyen, Binh Hoa; Nguyen, Hieu Duy; Tran, Nguyen Bich Chau; Nguyen, Thi; Le, Thanh Nhan Nguyen; Nguyễn, Việt Hùng; Phan, Teresa L.; Nguyen, Kim Cuong; Ho, Joy; Pham, Duc Cuong; Britton, Warwick J.; Bestrashniy, Jessica; Marks, Guy B.

doi:10.1093/cid/ciy665

Cited by 26 publications

(37 citation statements)

References 16 publications

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“…We observed that patients with tuberculosis died at a higher rate than the source population over 5 years of follow-up, similar to findings previously reported in India (SMR 6·1; for 2000–03) 10 . When considering those who survived the first year, we observed a SMR comparable to that reported in post-treatment cohorts in Israel (3·7; for 2000–10), 7 and Vietnam (4·0; for 2010–13) 11 . Although this study is restricted by not using individual data to build a cohort without tuberculosis and not disentangling excess mortality from tuberculosis itself or vulnerable conditions, we observed that patients with tuberculosis with vulnerable conditions had even higher excess mortality (SMR 8·1 over 5 years, and 5·3 for those who survived the first year), compared with the source population.…”

Section: Discussionsupporting

confidence: 89%

“…Previous studies showed that these conditions were associated with all-cause mortality, 3 particularly alcohol consumption, in high-income countries12, 28 and low-income and middle-income countries 10 . Although not estimated by a quantitative measure of association (eg, cause-specific HR), studies done in Israel 7 and Denmark 12 with death certificate data, together with the study from Vietnam, 11 which used verbal autopsy, reported a higher proportion of deaths probably associated with alcohol and drug use among patients with tuberculosis compared with the source population. We observed that, among patients with tuberculosis, lower acute respiratory infections and chronic respiratory diseases were the top causes of death, which is compatible with evidence showing post-tuberculosis lung sequelae 13 .…”

Section: Discussionmentioning

confidence: 99%

“…Most studies have described the survival of patients with tuberculosis while they received treatment or shortly after treatment completion 3 . To our knowledge, there are few studies concerning long-term tuberculosis survival (ie, 5 years after diagnosis),5, 6, 7, 8 and this knowledge is even scarcer in low-income and middle-income countries 3, 9, 10, 11. Moreover, detailed evaluation of causes of death in cohorts with tuberculosis has not received much attention 12 and there is a paucity of population-based studies that are not focused on tuberculosis and HIV coinfection.…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, detailed evaluation of causes of death in cohorts with tuberculosis has not received much attention 12 and there is a paucity of population-based studies that are not focused on tuberculosis and HIV coinfection. Evaluation of survival after tuberculosis treatment and associated causes of death allows quantification of the post-tuberculosis mortality burden and can be useful for planning preventive measures to mitigate post-tuberculosis sequelae 11, 13…”

Section: Introductionmentioning

confidence: 99%

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Long-term survival and cause-specific mortality of patients newly diagnosed with tuberculosis in São Paulo state, Brazil, 2010–15: a population-based, longitudinal study

Ranzani

Rodrigues

Bombarda

et al. 2020

The Lancet Infectious Diseases

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SummaryBackgroundLong-term survival and cause-specific mortality of patients who start tuberculosis treatment is rarely described. We aimed to assess the long-term survival of these patients and evaluate the association between vulnerable conditions (social, health behaviours, and comorbidities) and cause-specific mortality in a country with a high burden of tuberculosis.MethodsIn this population-based, longitudinal study in São Paulo state, Brazil, we described the 5-year survival of patients who were newly diagnosed with tuberculosis in 2010. We included patients with newly-diagnosed tuberculosis, aged 15 years or older, and notified to the São Paulo State Tuberculosis Program in 2010. We excluded patients whose diagnosis had changed during follow-up (ie, they did not have tuberculosis) and patients who had multidrug-resistant (MDR) tuberculosis. We selected our population with tuberculosis from the dedicated electronic system TBweb. Our primary objective was to estimate the excess mortality over 5 years and within the group who survived the first year, compared with the general São Paulo state population. We also estimated the association between social vulnerability (imprisonment and homelessness), health behaviours (alcohol and drug use), and comorbidities (diabetes and mental disorders) with all-cause and cause-specific mortality. We used the competing risk analysis framework, estimating cause-specific hazard ratios (HRs) adjusted for potential confounding factors.FindingsIn 2010, there were 19 252 notifications of tuberculosis cases. We excluded 550 cases as patients were younger than 15 years, 556 cases that were not tuberculosis, 2597 retreatments, and 48 cases of MDR tuberculosis, resulting in a final cohort of 15 501 patients with tuberculosis. Over a period of 5 years from tuberculosis diagnosis, 2660 (17%) of 15 501 patients died. Compared with the source population, matched by age, sex, and calendar year, the standardised mortality ratio was 6·47 (95% CI 6·22–6·73) over 5 years and 3·93 (3·71–4·17) among those who survived the first year. 1197 (45%) of 2660 deaths were due to infection. Homelessness and alcohol and drug use were associated with death from infection (adjusted cause-specific HR 1·60, 95% CI 1·39–1·85), cardiovascular (1·43, 1·06–1·95), and external or ill-defined causes of death (1·80, 1·37–2·36). Diabetes was associated with deaths from cardiovascular causes (1·70, 1·23–2·35).InterpretationPatients newly diagnosed with tuberculosis were at a higher risk of death than were the source population, even after tuberculosis treatment. Post-tuberculosis sequelae and vulnerability are associated with excess mortality and must be addressed to mitigate the tuberculosis burden worldwide.FundingWellcome Trust.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Long-term survival and cause-specific mortality of patients newly diagnosed with tuberculosis in São Paulo state, Brazil, 2010–15: a population-based, longitudinal study

Ranzani

Rodrigues

Bombarda

et al. 2020

The Lancet Infectious Diseases

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“…B. Einschränkung der Lungenfunktion) untersucht werden. Dies würde über das zeitliche Follow-up der meisten bisherigen internationalen Kohorten hinausgehen [17,18].…”

Section: Tuberkuloseunclassified

Selbst berichtete Infektionen in der NAKO Gesundheitsstudie – Einordnung in die gegenwärtige Forschungslandschaft

Hassenstein

Aarabi

Ahnert

et al. 2020

Bundesgesundheitsbl

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Zusammenfassung Hintergrund Infektionen spielen für das Krankheitsempfinden, für gesundheitsökonomische Überlegungen sowie Public Health in Deutschland weiterhin eine wichtige Rolle. Sie wurden in den letzten Jahren außerdem mit der Entstehung von nichtübertragbaren Erkrankungen in Zusammenhang gebracht. Die NAKO Gesundheitsstudie kann Erkenntnisse auf diesem Gebiet vertiefen und damit zielgenaueren präventiven Ansätzen den Weg bereiten. Ziel Die infektionsbezogenen Erhebungsinstrumente sollen beschrieben und in Bezug zu Erhebungsarten anderer deutscher Studien gesetzt werden. Zudem werden erste Daten zur Häufigkeit von Infektionskrankheiten berichtet. Methoden Fragen zu Infektionskrankheiten wurden in der NAKO-Basiserhebung sowohl im Interview als auch im Selbstausfüllerfragebogen (Touchscreen) gestellt. Es wurden die Daten der ersten 101.787 Teilnehmenden ausgewertet. Ergebnisse Das Auftreten von Herpes Zoster (HZ), Post-Zoster-Neuralgie (bei Angabe von HZ), Hepatitis B/C, HIV/Aids und Tuberkulose im Sinne einer ärztlichen Diagnose bzw. von Sepsis als Grund für eine stationäre Behandlung wurde von 0,2 % (HIV/Aids) bis 8,6 % (HZ) der Befragten im Interview angegeben. Im Touchscreenmodul wurde das mindestens einmalige Auftreten einer Infektion der oberen Atemwege (IOA), der unteren Atemwege, des Magen-Darm-Traktes, der Harnblase oder von Fieber in den letzten 12 Monaten von 12 % (Zystitis) bis 81 % (IOA) berichtet. Ausblick Weitere Ergebnisse anhand von Daten aus den hier vorgestellten Fragebögen sind im Querschnittsdesign – beispielsweise zu Determinanten der Anfälligkeit für selbst berichtete Infektionen – ab 2021 zu erwarten. Die Bearbeitung darüber hinausgehender Forschungsfragen der Infektionsepidemiologie wird insbesondere nach Analysen von NAKO-Bioproben möglich sein.

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Association of Mortality and Years of Potential Life Lost With Active Tuberculosis in the United States

et al. 2020

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Post-treatment Mortality Among Patients With Tuberculosis: A Prospective Cohort Study of 10 964 Patients in Vietnam

Abstract: Patients treated for tuberculosis had a markedly elevated risk of death, particularly in the post-treatment period. Interventions to reduce tuberculosis mortality must enhance the early detection of drug-resistance, improve treatment effectiveness, and address non-communicable diseases.

Cited by 26 publications

References 16 publications

Long-term survival and cause-specific mortality of patients newly diagnosed with tuberculosis in São Paulo state, Brazil, 2010–15: a population-based, longitudinal study

Long-term survival and cause-specific mortality of patients newly diagnosed with tuberculosis in São Paulo state, Brazil, 2010–15: a population-based, longitudinal study

Selbst berichtete Infektionen in der NAKO Gesundheitsstudie – Einordnung in die gegenwärtige Forschungslandschaft

Association of Mortality and Years of Potential Life Lost With Active Tuberculosis in the United States

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