Clinical, health systems and neighbourhood determinants of tuberculosis case fatality in urban Blantyre, Malawi: a multilevel epidemiological analysis of enhanced surveillance data
Clinical, health systems and neighbourhood determinants of tuberculosis case fatality in urban Blantyre, Malawi: a multilevel epidemiological analysis of enhanced surveillance data
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马拉维城市布兰蒂尔的结核病病死的临床，卫生系统和邻里决定因素：增强监视数据的多级流行病学分析
DOI：
10.1017/s0950268821001862
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发表时间：
2021-09-02
影响因子：
4.2
通讯作者：
Carpenter JR
中科院分区：
文献类型：
--
作者：
Khundi M;MacPherson P;Feasey HR;Nzawa Soko R;Nliwasa M;Corbett EL;Carpenter JR
我们调查了家庭到诊所的距离是否是马拉维结核病（TB）治疗死亡的危险因素。利用增强的结核病监测数据，我们记录了2015年至2018年期间所有结核病治疗的启动和结果。家庭的地理位置，距离测量直线或最短的道路网络。我们构建了贝叶斯多层次逻辑回归模型来研究距离和病死率之间的关系。共有479/4397（10.9%）例结核病患者死亡。在转诊医院登记的结核病患者中，距离越远，死亡几率越高（比值比（OR）为每公里增加1.07，95%可信区间（CI）为0.99-1.16），但在初级诊所登记的结核病患者中则不然（OR为每公里增加0.98，95% CI为0.92-1.03）。年龄（OR每年增加1.02，95%CI 1.01-1.02）和艾滋病毒阳性状态（OR 2.21，95%CI 1.73-2.85）也与较高的死亡几率相关。两种距离测量的模型估计值相似。距离是主要转诊医院患者死亡的一个风险因素，可能是由于诊断延迟和医疗服务不佳。为了降低死亡率，需要针对结核病和艾滋病毒采取有针对性的社区结核病筛查干预措施，并扩大新的敏感诊断测试。
We investigated whether household to clinic distance was a risk factor for death on tuberculosis (TB) treatment in Malawi. Using enhanced TB surveillance data, we recorded all TB treatment initiations and outcomes between 2015 and 2018. Household locations were geolocated, and distances were measured by a straight line or shortest road network. We constructed Bayesian multi-level logistic regression models to investigate associations between distance and case fatality. A total of 479/4397 (10.9%) TB patients died. Greater distance was associated with higher (odds ratio (OR) 1.07 per kilometre (km) increase, 95% credible interval (CI) 0.99–1.16) odds of death in TB patients registered at the referral hospital, but not among TB patients registered at primary clinics (OR 0.98 per km increase, 95% CI 0.92–1.03). Age (OR 1.02 per year increase, 95% CI 1.01–1.02) and HIV-positive status (OR 2.21, 95% CI 1.73–2.85) were also associated with higher odds of death. Model estimates were similar for both distance measures. Distance was a risk factor for death among patients at the main referral hospital, likely due to delayed diagnosis and suboptimal healthcare access. To reduce mortality, targeted community TB screening interventions for TB disease and HIV, and expansion of novel sensitive diagnostic tests are required.