Tuberculosis Mortality in the United States: Epidemiology and Prevention Opportunities
Tuberculosis Mortality in the United States: Epidemiology and Prevention Opportunities
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DOI：
10.1513/annalsats.201705-405oc
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发表时间：
2018-06-01
影响因子：
8.3
通讯作者：
Flood, Jennifer M.
中科院分区：
文献类型：
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作者：
Beavers, Suzanne F.;Pascopella, Lisa;Flood, Jennifer M.
理论基础：在美国，更多关于结核病死亡风险因素的信息有助于降低结核病死亡率，结核病死亡率十多年来一直保持稳定。目的：确定成人结核病相关死亡的风险因素。方法：我们对2005年至2006年在13个州报告65%的美国结核病病例的1,304名在治疗结束前死亡的成人结核病患者和1,039名完成结核病治疗的频率匹配的对照组受试者进行了回顾性研究。我们使用了深入的记录提取和标准算法来将结核病患者的死亡归类为与结核病相关的或与之无关的。然后，我们将这些分类与死亡证明中编码的死因进行了比较。结果：在1304例成人死亡病例中，942例(72%)为结核病相关死亡，272例(21%)与结核病无关，90例(7%)无法分类。在有死亡证明的847例结核病相关死亡病例中，378例(45%)未将结核病列为死因。调整已知的风险，我们确定了治疗期间结核病相关死亡的新风险：初始方案中没有吡嗪酰胺(调整后的优势比，3.4；95%可信区间，1.9-6.0)；免疫抑制药物(调整后的优势比，2.5；95%的可信区间，1.1-5.6)；不完整的结核病诊断评估(调整后的优势比，2.2；95%的可信区间，1.5-3.3)，以及结核病诊断前的替代非结核病诊断(调整后的优势比，1.6；95%可信区间1.2-2.2)。结论：大多数死于结核病的人都有结核病相关死亡。密集的记录审查显示，结核病是死因之一，比死亡证明诊断更常见。新的工具，如基于我们的研究结果的结核病死亡风险评分，可能会识别结核病患者，以便进行住院干预以防止死亡。
Rationale: More information on risk factors for death from tuberculosis in the United States could help reduce the tuberculosis mortality rate, which has remained steady for more than a decade.Objective: To identify risk factors for tuberculosis-related death in adults.Methods: We performed a retrospective study of 1,304 adults with tuberculosis who died before treatment completion and 1,039 frequency-matched control subjects who completed tuberculosis treatment in 2005 to 2006 in 13 states reporting 65% of U.S. tuberculosis cases. We used in-depth record abstractions and a standard algorithm to classify deaths in persons with tuberculosis as tuberculosis-related or not. We then compared these classifications to causes of death as coded in death certificates. We used multivariable logistic regression to calculate adjusted odds ratios for predictors of tuberculosis-related death among adults compared with those who completed tuberculosis treatment.Results: Of 1,304 adult deaths, 942 (72%) were tuberculosis related, 272 (21%) were not, and 90 (7%) could not be classified. Of 847 tuberculosis-related deaths with death certificates available, 378 (45%) did not list tuberculosis as a cause of death. Adjusting for known risks, we identified new risks for tuberculosis-related death during treatment: absence of pyrazinamide in the initial regimen (adjusted odds ratio, 3.4; 95% confidence interval, 1.9-6.0); immunosuppressive medications (adjusted odds ratio, 2.5; 95% confidence interval, 1.1-5.6); incomplete tuberculosis diagnostic evaluation (adjusted odds ratio, 2.2; 95% confidence interval, 1.5-3.3), and an alternative nontuberculosis diagnosis before tuberculosis diagnosis (adjusted odds ratio, 1.6; 95% confidence interval, 1.2-2.2).Conclusions: Most persons who died with tuberculosis had a tuberculosis-related death. Intensive record review revealed tuberculosis as a cause of death more often than did death certificate diagnoses. New tools, such as a tuberculosis mortality risk score based on our study findings, may identify patients with tuberculosis for in-hospital interventions to prevent death.