Association of Mortality and Years of Potential Life Lost With Active Tuberculosis in the United States.
Association of Mortality and Years of Potential Life Lost With Active Tuberculosis in the United States.
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DOI：
10.1001/jamanetworkopen.2020.14481
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发表时间：
2020-09-01
影响因子：
13.8
通讯作者：
Skarbinski J
中科院分区：
文献类型：
--
作者：
Lee-Rodriguez C;Wada PY;Hung YY;Skarbinski J
这项队列研究检查了活动性结核病患者与非活动性结核病患者相比的死亡风险和潜在寿命损失。活动性结核病患者延迟死亡（即结核病诊断后1年以上）的风险是否增加？在这项队列研究中，2522例活动性结核病患者在结核病诊断后1年以上死亡风险增加78%，与100880例无活动性结核病患者的匹配对照队列相比。这些研究结果表明，与活动性结核病相关的死亡风险和寿命损失被低估;活动性结核病患者的死亡风险似乎长期增加。活动性结核病导致大量死亡，但可以通过筛查和治疗潜伏性结核感染来预防。结核病诊断后的早期死亡率（≤1年）已得到充分描述，但对活动性结核病患者的延迟死亡率（>1年）了解甚少。比较活动性结核病患者与无活动性结核病的年龄、性别和诊断年份匹配的对照队列的早期和延迟死亡率以及潜在寿命（YPL）损失。这项回顾性队列研究在Kaiser Permanente北方加州的综合卫生系统中进行，包括1997年1月1日至2017年12月31日期间经微生物学证实的活动性结核病患者，以及按年龄、性别和诊断年份匹配的对照队列。多变量模型用于调整人口统计学和临床特征。1997年以前患有活动性结核病的患者被排除在外。分析了2019年1月1日至2020年1月31日的数据。微生物证实的结核病。早期（结核病诊断后≤1年）和延迟（结核病诊断后>1年）全因死亡率。从1997年到2017年，共有2522名活动性结核病患者被确定，随访时间为17166人年。比较队列包括100 880人，随访735 726人年。在活动性结核和对照队列中，男性（56.3% vs 55.6%）、45至64岁（33.7% vs 33.7%）和65岁或以上（24.7% vs 24.7%）的比例相似。活动性结核病患者的早期死亡率（7.0%）和延迟死亡率（16.3%）均高于非活动性结核病患者（分别为1.1%和12.0%）。与对照组相比，活动性结核病患者的早期（校正风险比[aHR]，7.29; 95%CI，6.08-8.73）和延迟（aHR，1.78; 95%CI，1.61-1.98）死亡风险显著更高（P <0.001）。与对照队列相比，活动性结核病与调整后的-7.0（95%CI，-8.4至5.5）YPL损失相关。在这项研究中，当调整人口统计学和临床特征时，活动性结核病患者的早期和延迟全因死亡率显著较高。这些研究结果表明，通过筛查和治疗潜伏性结核感染来预防结核病可以降低由于活动性结核病导致的死亡率和YPL损失。
This cohort study examines the risk of mortality and years of potential life lost among patients with active tuberculosis disease compared with individuals without active tuberculosis. Do patients with active tuberculosis disease have an increased risk of delayed mortality (ie, more than 1 year after tuberculosis diagnosis)? In this cohort study, 2522 patients with active tuberculosis disease had a 78% increased risk of death more than 1 year after tuberculosis diagnosis compared with a matched comparison cohort of 100 880 individuals without active tuberculosis. These findings suggest that the mortality risk and longevity loss associated with active tuberculosis disease is underappreciated; patients with active tuberculosis disease appear to have a long-term increased risk of mortality. Active tuberculosis (TB) disease leads to substantial mortality but is preventable through screening and treatment for latent TB infection. Early mortality after TB diagnosis (≤1 year) is well described, but delayed mortality (>1 year) among patients with active TB is poorly understood. To compare early and delayed mortality and years of potential life (YPL) lost among patients with active TB disease vs an age-, sex-, and year of diagnosis–matched comparison cohort without active TB disease. This retrospective cohort study, conducted in the integrated health system of Kaiser Permanente Northern California, included patients with microbiologically confirmed active TB disease from January 1, 1997, to December 31, 2017, and a control cohort matched by age, sex, and year of diagnosis. Multivariable models were used to adjust for demographic and clinical characteristics. Patients with active TB disease prior to 1997 were excluded. Data were analyzed from January 1, 2019, to January 31, 2020. Microbiologically confirmed TB disease. Early (≤1 year after TB diagnosis) and delayed (>1 year after TB diagnosis) all-cause mortality. A total of 2522 patients who had active TB from 1997 to 2017 were identified, with 17 166 person-years of follow-up. The comparison cohort included 100 880 persons with 735 726 person-years of follow-up. In the active TB and comparison cohorts, similar percentages of persons were male (56.3% vs 55.6%), aged 45 to 64 years (33.7% vs 33.7%), and aged 65 years or older (24.7% vs 24.7%). Both early mortality (7.0%) and delayed mortality (16.3%) were higher among patients with active TB disease compared with those without active TB disease (1.1% and 12.0%, respectively). Patients with active TB disease had a significantly higher risk for early (adjusted hazard ratio [aHR], 7.29; 95% CI, 6.08-8.73) and delayed (aHR, 1.78; 95% CI, 1.61-1.98) mortality compared with the comparison cohort (P < .001). Active TB disease was associated with an adjusted −7.0 (95% CI, −8.4 to −5.5) YPL lost compared with the comparison cohort. In this study, patients with active TB disease had significantly higher early and delayed all-cause mortality when adjusting for demographic and clinical characteristics. These findings suggest that TB prevention through screening and treatment of latent TB infection could reduce mortality and YPL lost due to active TB disease.
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影响因子：
11.8
作者：
Fox, G. J.;Nguyen, V. N.;Marks, G. B.
通讯作者：
Marks, G. B.
影响因子：
3.7
作者：
Millet JP;Orcau A;Rius C;Casals M;de Olalla PG;Moreno A;Nelson JL;Caylà JA;Barcelona Tuberculosis Working Group
通讯作者：
Barcelona Tuberculosis Working Group
影响因子：
--
作者：
de Perio, Marie A.;Tsevat, Joel;Eckman, Mark H.
通讯作者：
Eckman, Mark H.
DOI：
10.5588/ijtld.14.0242
发表时间：
2014-11-01
影响因子：
4
作者：
Hoger, S.;Lykens, K.;Miller, T. L.
通讯作者：
Miller, T. L.
DOI：
10.5588/ijtld.12.0946
发表时间：
2013-07-01
影响因子：
4
作者：
Bloendal, K.;Rahu, K.;Rahu, M.
通讯作者：
Rahu, M.