Long-term mortality in patients with pulmonary and extrapulmonary tuberculosis: a Danish nationwide cohort study
Long-term mortality in patients with pulmonary and extrapulmonary tuberculosis: a Danish nationwide cohort study
复制标题
DOI：
10.2147/clep.s65331
复制
发表时间：
2014-01-01
影响因子：
3.9
通讯作者：
Obel, Niels
中科院分区：
文献类型：
--
作者：
Christensen, Anne-Sophie Halkjaer;Roed, Casper;Obel, Niels
背景：肺结核（PTB）和肺外结核（EPTB）患者的长期死亡率和死因记录很少。本研究将 PTB 和 EPTB 患者的长期死亡率和死因与背景人群进行比较，并调查死亡率是否与家庭相关危险因素相关。 方法：进行了一项全国性队列研究，包括：1977 年至 2008 年报告患有 PTB 或 EPTB 且诊断后存活 1 年的所有成年丹麦人；随机选择的出生日期和性别相匹配的比较队列； PTB 患者的成年兄弟姐妹；和人口控制。数据是从国家登记处提取的。计算了患者和兄弟姐妹的全因和特定原因死亡率比率，并与各自的对照组进行比较。总共包括 8,291 名患者（6,402 名 PTB 和 1,889 EPTB）、24,873 名对照人群、1,990 名 PTB 患者的兄弟姐妹和 11,679 名 PTB 人群对照的兄弟姐妹。 结果：总体而言，PTB 患者的死亡率比为 1.86（95% 置信区间 [CI] 1.77-1.96），PTB 患者的死亡率比为 1.24。 (95% CI 1.12-1.37) EPTB 患者。两个患者队列因传染病和糖尿病而死亡的风险均显着增加。此外，PTB患者因癌症（主要是呼吸道和胃肠道）、肝脏和呼吸系统疾病以及酒精和药物滥用而导致的死亡率增加。与他们的兄弟姐妹相比，PTB 患者的死亡率增加（死亡率比 3.55；95% CI 2.57-4.91），PTB 患者的兄弟姐妹与人群对照的兄弟姐妹相比死亡率也增加（死亡率比 2.16；95% CI 1.62-2.87）。 结论：我们的结论是，成年 PTB 患者的长期死亡率几乎增加了两倍，而 EPTB 患者的长期死亡率略有增加与背景人群相比的长期死亡率。 PTB患者长期死亡率的增加源于与酒精、烟草和药物滥用相关的疾病以及免疫抑制和家庭相关因素。
Background: Long-term mortality and causes of death in patients with pulmonary tuberculosis (PTB) and extrapulmonary tuberculosis (EPTB) are poorly documented. In this study, long-term mortality and causes of death in PTB and EPTB patients were compared with the background population and it was investigated whether mortality was associated with family-related risk factors.Methods: A nationwide cohort study was conducted including: all adult Danes notified with PTB or EPTB from 1977 to 2008 and alive 1 year after diagnosis; a randomly selected comparison cohort matched on birth date and sex; adult siblings of PTB patients; and population controls. Data were extracted from national registries. All-cause and cause-specific mortality rate ratios were calculated for patients and siblings and compared with their respective control cohorts. A total of 8,291 patients (6,402 PTB and 1,889 EPTB), 24,873 population controls, 1,990 siblings of PTB patients and 11,679 siblings of PTB population controls were included.Results: Overall, the mortality rate ratio was 1.86 (95% confidence interval [CI] 1.77-1.96) for PTB patients and 1.24 (95% CI 1.12-1.37) for EPTB patients. Both patient cohorts had significantly increased risk of death due to infectious diseases and diabetes. Further, the PTB patients had increased mortality due to cancers (mainly respiratory and gastrointestinal tract), liver and respiratory system diseases, and alcohol and drug abuse. The PTB patients had increased mortality compared with their siblings (mortality rate ratio 3.55; 95% CI 2.57-4.91) as did the siblings of the PTB patients compared with the siblings of population controls (mortality rate ratio 2.16; 95% CI 1.62-2.87).Conclusion: We conclude that adult PTB patients have an almost two-fold increased long-term mortality whereas EPTB patients have a slightly increased long-term mortality compared with the background population. The increased long-term mortality in PTB patients stems from diseases associated with alcohol, tobacco, and drug abuse as well as immune suppression, and family-related factors.