The Profile and Treatment Outcomes of the Older (Aged 60 Years and Above) Tuberculosis Patients in Tamilnadu, South India

Abstract

BackgroundWith changing demographic patterns in the context of a high tuberculosis (TB) burden country, like India, there is very little information on the clinical and demographic factors associated with poor treatment outcome in the sub-group of older TB patients. The study aimed to assess the proportion of older TB patients (60 years of age and more), to compare the type of TB and treatment outcomes between older TB patients and other TB patients (less than 60 years of age) and to describe the demographic and clinical characteristics of older TB patients and assess any associations with TB treatment outcomes.MethodsA retrospective cohort study involving a review of records from April to June 2011 in the 12 selected districts of Tamilnadu, India. Demographic, clinical and WHO defined disease classifications and treatment outcomes of all TB patients aged 60 years and above were extracted from TB registers maintained routinely by Revised National TB Control Program (RNTCP).ResultsOlder TB patients accounted for 14% of all TB patients, of whom 47% were new sputum positive. They had 38% higher risk of unfavourable treatment outcomes as compared to all other TB patients (Relative risk (RR)-1.4, 95% CI 1.2–1.6). Among older TB patients, the risk for unfavourable treatment outcomes was higher for those aged 70 years and more (RR 1.5, 95% CI 1.2–1.9), males (RR 1.5, 95% CI 1.0–2.1), re-treatment patients (RR 2.5, 95% CI 1.9–3.2) and those who received community-based Direct Observed Treatment (RR 1.4, 95% CI 1.1–1.9).ConclusionTreatment outcomes were poor in older TB patients warranting special attention to this group – including routine assessment and recording of co-morbidities, a dedicated recording, reporting and monitoring of outcomes for this age-group and collaboration with National programme of non-communicable diseases for comprehensive management of co-morbidities.

Risk factors for unfavourable treatment outcome among new smear-positive pulmonary tuberculosis cases in China

“…12,13 One study in India reported that older TB patients had a 38% higher risk of UTO compared to other TB patients. 14 This was similar to our findings. Delay in accessing health services has been reported to be significantly associated with increased age, and has been highlighted in other research.…”

Tuberculosis case burden and treatment outcomes in children, adults and older adults, Vanuatu, 2007–2011

“…This may be influenced by the effects of human immunodeficiency virus (HIV) co-infection in Africa, 12,13 but may also reflect limited access to CXR in the study setting. Our findings in older adults are also similar to those reported recently in India, 15 although the prevalence of smear-positive PTB was higher among older adult patients in India. In a country with limited diagnostic resources such as Vanuatu, it is possible that older patients have a higher prevalence of chronic lung disease with various aetiologies that are potentially misdiagnosed as smear-negative PTB based on negative sputum smears and abnormal CXR.…”

“…12,13 The poor outcomes among adults aged 65 years in the present study are in line with the recent report from India showing poor treatment outcomes among older TB patients, particularly among those aged 70 years. 15 The high death rates among older adults observed in our study could be due in part to comorbidities such as diabetes mellitus, hypertension and associated cardiovascular diseases, (3) 5 (1) 42 (7) 22 (4) 14 (2) * Includes cured and treatment completed. † Row percentages.…”

Predictors of unfavourable treatment outcome in patients with multidrug-resistant tuberculosis in India

“…11 In countries in Asia, Eastern Europe and Latin America, patients aged 40 years with MDR-TB have also been reported to have worse outcomes than younger patients. [12][13][14] The higher rate of unfavourable outcomes among older adults observed in our study and elsewhere could be due in part to co-morbidities such as diabetes mellitus, hypertension and associated cardiovascular diseases, which are becoming increasingly prevalent in Asia and India.…”