Factors Associated With Latent Tuberculosis Infection Treatment Failure Among Patients With Commercial Health Insurance-United States, 2005-2016
Factors Associated With Latent Tuberculosis Infection Treatment Failure Among Patients With Commercial Health Insurance-United States, 2005-2016
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DOI：
10.1097/phh.0000000000001077
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发表时间：
2021-07-01
影响因子：
3.3
通讯作者：
Truman, Benedict I.
中科院分区：
文献类型：
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作者：
Iqbal, Shareen A.;Isenhour, Cheryl J.;Truman, Benedict I.
在2015-2016年期间证实的美国结核病（TB）病例中，约有80%归因于未经治疗的潜伏性TB感染（LTBI）。识别与LTBI治疗失败相关的因素可能会提高治疗effectiveness.Objective：To identify patients with indicators of isoniazid（INH）LTBI treatment initiation，completion，and failure.Methods：我们检索了国际疾病分类（第九和第十版）、国家药物和当前程序术语代码的住院和门诊索赔。我们将治疗完成定义为在9个月期间接受INH治疗180天或以上。我们将LTBI治疗失败定义为在完成者中开始LTBI治疗后超过1年的活动性TB疾病诊断，并使用精确的逻辑回归来模拟组间可能的差异。在治疗完成者中，我们将1名治疗失败的患者与2名对照受试者进行匹配，并将回归模型与INH治疗开始前6个月或更短时间内支付的医疗索赔记录的协变量进行拟合。参与者：大型商业数据库中的商业保险美国患者，在2005- 2016年期间支付保险索赔。主要结果测量：（1）治疗完成的趋势;（2）与治疗完成和治疗失败相关的因素的比值比（OR）。在2005-2016年期间开始LTBI治疗的21510人中，有10725人（49.9%）完成了治疗。未完成治疗与年龄小于45岁、居住在东北部或南部人口普查地区以及女性有关。在完成治疗的人中，30人（0.3%）进展为结核病。治疗开始前6个月内诊断为类风湿性关节炎，年龄≥ 65岁（参考：0-24岁）与INH LTBI治疗失败显著相关（校正的精确OR = 5.1; 95%CI，1.2-28.2;和校正的精确OR = 5.1; 95%CI，1.2-25.3）。大约50%的人完成了INH LTBI治疗，其中，治疗失败与类风湿性关节炎相关，并且在一组有商业健康保险的美国LTBI患者中，65岁或以上的人。
Context:Approximately 80% of US tuberculosis (TB) cases verified during 2015-2016 were attributed to untreated latent TB infection (LTBI). Identifying factors associated with LTBI treatment failure might improve treatment effectiveness.Objective:To identify patients with indicators of isoniazid (INH) LTBI treatment initiation, completion, and failure.Methods:We searched inpatient and outpatient claims for International Classification of Diseases (Ninth and Tenth Revisions), National Drug, and Current Procedural Terminology codes. We defined treatment completion as 180 days or more of INH therapy during a 9-month period. We defined LTBI treatment failure as an active TB disease diagnosis more than 1 year after starting LTBI treatment among completers and used exact logistic regression to model possible differences between groups. Among treatment completers, we matched 1 patient who failed treatment with 2 control subjects and fit regression models with covariates documented on medical claims paid 6 months or less before INH treatment initiation.Participants:Commercially insured US patients in a large commercial database with insurance claims paid during 2005-2016.Main Outcome Measures:(1) Trends in treatment completion; (2) odds ratios (ORs) for factors associated with treatment completion and treatment failure.Results:Of 21 510 persons who began LTBI therapy during 2005-2016, 10 725 (49.9%) completed therapy. Treatment noncompletion is associated with those younger than 45 years, living in the Northeast or South Census regions, and women. Among persons who completed treatment, 30 (0.3%) progressed to TB disease. Diagnoses of rheumatoid arthritis during the 6 months before treatment initiation and being aged 65 years or older (reference: ages 0-24 years) were significantly associated with INH LTBI treatment failure (adjusted exact OR = 5.1; 95% CI, 1.2-28.2; and adjusted exact OR = 5.1; 95% CI, 1.2-25.3, respectively).Conclusion:Approximately 50% of persons completed INH LTBI therapy, and of those, treatment failure was associated with rheumatoid arthritis and persons 65 years or older among a cohort of US LTBI patients with commercial health insurance.