Mortality in South African Children and Adolescents Routinely Treated for Tuberculosis.
Mortality in South African Children and Adolescents Routinely Treated for Tuberculosis.
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DOI：
10.1542/peds.2020-032490
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发表时间：
2021-04
期刊：
影响因子：
8
通讯作者：
Hesseling AC
中科院分区：
文献类型：
--
作者：
Osman M;du Preez K;Seddon JA;Claassens MM;Dunbar R;Dlamini SS;Welte A;Naidoo P;Hesseling AC
在南非，结核病是20岁以下人群的主要死因。我们描述了13年来南非儿童和青少年结核病死亡率的变化，确定了死亡率的危险因素，并估计了结核病相关死亡率。对国家药物敏感结核病治疗电子登记册（2004-2016年）中常规记录的所有<20岁患者进行回顾性分析。我们开发了一个多变量考克斯回归模型来预测死亡率，并使用一般人群的死亡率估计值来计算标准化死亡率比（SMR）。在2004年至2016年期间，有729463名儿童和青少年接受了结核病治疗; 84.0%的儿童和青少年有治疗结果，2.5%（18539人）在结核病治疗期间死亡。病死率从2007年的3.3%下降到2016年的1.9%。在多变量考克斯回归模型中，0 - 4岁、10 - 14岁和15 - 19岁（与5 - 9岁相比）与死亡风险增加相关，HIV感染、既往TB治疗和肺外受累也是如此。15 - 19岁女性患者的SMR是同龄男性患者的两倍多（55.3 vs 26.2）。在10至14岁的青少年和艾滋病毒阳性者中，SMRs随着时间的推移而增加。南非儿童和青少年接受结核病治疗的死亡率正在下降，但仍相当可观，2016年死亡率为2%。青少年（10至19岁）和艾滋病毒感染者的死亡风险最高，最低标准死亡率最高。迫切需要采取干预措施来降低结核病治疗期间的死亡率，特别是针对高风险人群。
In South Africa, tuberculosis (TB) is a leading cause of death among those <20 years of age. We describe changes in TB mortality among children and adolescents in South Africa over a 13-year period, identify risk factors for mortality, and estimate excess TB-related mortality. Retrospective analysis of all patients <20 years of age routinely recorded in the national electronic drug-susceptible TB treatment register (2004–2016). We developed a multivariable Cox regression model for predictors of mortality and used estimates of mortality among the general population to calculate standardized mortality ratios (SMRs). Between 2004 and 2016, 729 463 children and adolescents were recorded on TB treatment; 84.0% had treatment outcomes and 2.5% (18 539) died during TB treatment. The case fatality ratio decreased from 3.3% in 2007 to 1.9% in 2016. In the multivariable Cox regression model, ages 0 to 4, 10 to 14, and 15 to 19 years (compared with ages 5 to 9 years) were associated with increased risk of mortality, as was HIV infection, previous TB treatment, and extrapulmonary involvement. The SMR of 15 to 19-year-old female patients was more than double that of male patients the same age (55.3 vs 26.2). Among 10 to 14-year-olds and those who were HIV-positive, SMRs increased over time. Mortality in South African children and adolescents treated for TB is declining but remains considerable, with 2% dying during 2016. Adolescents (10 to 19 years) and those people living with HIV have the highest risk of mortality and the greatest SMRs. Interventions to reduce mortality during TB treatment, specifically targeting those at highest risk, are urgently needed.