Treatment delay and fatal outcomes of pulmonary tuberculosis in advanced age: a retrospective nationwide cohort study

Abstract

Background and objective: Studies focusing on pulmonary tuberculosis in advanced age (≥80 years) are lacking. This study aimed to explore treatment delay, outcomes and their predictors in this group. Methods: Adult (≥20 years) patients with pulmonary tuberculosis were identified from the National Health Insurance Research Database of Taiwan from 2004 to 2009. Treatment completion and mortality rates were noted at one year after treatment. Results: Among the 81,081 patients with pulmonary tuberculosis identified, 13,923 (17.2%) were aged ≥80 years, and 26,897 (33.2%) were aged 65-79 years. The treatment completion, mortality rates and treatment delay were 54. 8%, 34.7% and 61 (12-128) [median, (1st-3rd quartiles)] days in patients aged ≥80 years, 68.3%, 18.5% and 53 (8-122) days in patients aged 65-79 years, and 78.9%, 6.5% and 21 (1-84) days in patients aged <65 years, respectively. The elder patients were more likely to receive second-line anti-tuberculosis agents. The treatment completion rate decreased with older age, female sex, comorbidities, low income, requiring second-line anti-tuberculosis agents, severity of pulmonary tuberculosis and longer treatment delay. Older age, female sex, comorbidities, low income, and not undergoing rapid molecular diagnostic tests were independently associated with longer treatment delays. Conclusions: Pulmonary tuberculosis in advanced age has a longer treatment delay and a higher mortality rate. Applying rapid molecular diagnostic tools may reduce treatment delay and should be integrated into the diagnostic algorithm for pulmonary tuberculosis, particularly in elderly patients.

Factors Contributing to Treatment Delay Among Pulmonary Tuberculosis Patients in Melaka

“…The findings showed that patients' age was not a predictor for treatment delay, similar with studies by (Said et al, 2017;Dos Santos et al, 2005). This is in contrast with several studies (Ukwaja et al, 2013;Lee et al, 2017;Gebreegziabher et al, 2016). One possible explanation age was not significant is due to majority of the respondents were from 18-29 years old (29%), with lower mean and median, as compared with other studies findings.…”

“…For molecular test, several studies reported that patients not undergoing the test, significantly associated with treatment delay (Lee et al, 2017;Takarinda et al, 2015). In Melaka, this test was not a significant factor associated with treatment delay.…”

Epidemiological, clinical and mechanistic perspectives of tuberculosis in older people

“…In Japan, the treatment success rates for older and younger people in 2007 were 71% and 87%, respectively, and the death rates were 21% versus 3%, respectively . Aside from smoking and DM, other factors contributing to adverse outcomes in geriatric TB include delayed treatment, end‐stage renal disease, immunosuppression, malignancy, poor nutrition with low albumin level and decreased activity of daily living …”

“…In Japan, the treatment success rates for older and younger people in 2007 were 71% and 87%, respectively, and the death rates were 21% versus 3%, respectively. 12 Aside from smoking and DM, other factors contributing to adverse outcomes in geriatric TB include delayed treatment, 34 endstage renal disease, 35 immunosuppression, 35 malignancy, 36 poor nutrition with low albumin level and decreased activity of daily living. 37 Older patients are more likely to experience antituberculosis drug-induced adverse reactions, as a result of polypharmacy related to co-morbidities, as well as physiological and pathological changes from ageing and concomitant diseases, respectively, such as renal, hepatic and other organ dysfunctions.…”

Impact of introducing fluorescent microscopy on hospital tuberculosis control: A before-after study at a high caseload medical center in Taiwan

“…Therefore, hospitalization of undiagnosed TB patients for treatment of comorbidities is more than just a coincidence by chance. In low HIV prevalence countries, TB is a disease of elderly [30]. With population aging, concurrence of TB and comorbidities could be an increasing challenge to clinicians.…”