Tuberculosis Incidence in Elderly in Serbia: Key Trends in Socioeconomic Transition

Abstract

Aim To examine tuberculosis incidence rates among the elderly in Central Serbia in 1992-2006 period, which was characterized by socioeconomic crisis and migration of population.Methods We analyzed all reported active tuberculosis cases in a 15-year period, especially among patients aged ≥65, according to the Annual Reports of the Institute of Lung Diseases and Tuberculosis in Belgrade and Central Tuberculosis Register. Population estimates with extrapolations were based on 1991 and 2002 census data.Results Total tuberculosis incidence rates showed a slight but nonsignificant decreasing trend (P = 0.535), and no significant increase was found in patients aged ≥65 years (P = 0.064), with an average agespecific incidence rate for the elderly of 64.0 (95% confidence interval, 60.7-67.4). The increase was significant in patients aged ≥70 years (y = 49.3549 + 2.1186x; P = 0.001), both in men (y = 62.8666 + 2.3977x; P = 0.005) and even more prominently in women (y = 39.8240 + 1.9150x; P < 0.001). The proportion of tuberculosis cases in the elderly peaked in 2005, with 35% of all tuberculosis cases.Conclusion High incidence rates and increasing time trend of tuberculosis in the elderly in Central Serbia is a serious problem, especially among those aged 70 years and over, who might present a target group for active case-finding of the disease.

Diagnóstico da tuberculose em pessoas idosas: barreiras de acesso relacionadas aos serviços de saúde

“…The organiza onal form of TB care was not found to be determining factor that could guarantee access to an early diagnosis (6) . As the decentraliza on of pa ent care for TB to the FHU was intended to increase pa ent access to care, the fact that the func oning hours are a limi ng factor demonstrates a contradic on in this care model.…”

“…Several notable aspects that are related to a delay in the diagnosis of TB include the following: the diffi culty of access to health care; inappropriate welcoming of the pa ent; low priority in the search for respiratory symptoma cs (RS) and intra-home contacts; and a low level of diagnos c suspicion of TB, resul ng in an increased period between the fi rst visit to the health service and the ini aon of an tuberculosis treatment (6) .…”

Time trend and clinical pattern of extrapulmonary tuberculosis in Serbia, 1993-2007

“…This latter usually happens easier in immune compromised host 2, 3 . Some other risk factors are of higher importance in developing TB such as stress and malnutrition, diabetes mellitus, chronic alcohol and tobacco abuse, and coexisting malignant disease, which are especially prominent in the existed and newly appeared risk groups [5][6][7] . Nowadays, Serbia is an intermediate-low TB incidence country 4 .…”

Comorbidades e estilo de vida de idosos com tuberculose

“…Em um estudo realizado na Sérvia, observou-se que o fator de risco mais importante para o desenvolvimento da infecção tuberculosa no idoso é considerada a reativação da doença que tinha sido adquirida anteriormente (22) . Outro estudo, realizado no Rio de Janeiro, mostra que o desenvolvimento da TB pode ter sido preferencialmente endógeno, pois 70% dos idosos não tinham antecedentes da doença (15) .…”