1171 National Burden of Gastrointestinal Tuberculosis: Insights From the Nationwide Inpatient Sample

Abstract

INTRODUCTION: Gastrointestinal tuberculosis (GI TB) is a rare and morbid extrapulmonary manifestation of TB. There is scant published data regarding the prevalence of GI TB. ThE aim of our study was to assess the overall burden of inpatient GI TB in the United States. We also looked at demographic characteristics, comorbidities and all-cause inpatient mortality among patients with GI TB. METHODS: All adults hospitalized with the diagnosis of either gastric TB or intestinal TB or both, during the years 2010 to 2014, were identified using the Nationwide Inpatient Sample (NIS). Patients with tuberculous associated peritonitis were also included. We studied racial, regional and gender-specific characteristics of these patients. Other demographic data such as risk factors and comorbidities were also identified. Outcomes of interest included inpatient mortality and length of stay. RESULTS: During the five-year study period, there were a total of 2,300 inpatient hospital admissions for GI TB. We observed a downward trend in the prevalence of GI TB in the US during this time (469 vs 340 vs 380 vs 329 vs 78; P = 0.56) (Figure 1). Patients affected were predominantly Hispanic (36.04% vs 53.99% vs 24.78% vs 30.17%; P = 0.002) in all four regions. Several other comorbidities and conditions were identified as enlisted in Table 1. The overall inpatient mortality (6.25% vs 1.20% vs 2.61% vs 3.24%; P = 0.206) and mean length of stay (18.11 vs 9.07 vs 10.56 vs 14.57 days; P = 0.001) were highest in the NE region as compared to MW, SO and WE regions. In addition, hospitalized patients with GI TB were less likely to be female in Northeastern (NE) states (30.91% vs 56.29% vs 51.64% vs 50.64%; P = 0.05) as compared to Midwest (MW), Southern (SO) and Western (WE) states. CONCLUSION: Since the introduction of antituberculous therapy, the global and national overall burden of GI TB has decreased significantly. It is, however, important to note that although rare, GI TB continue to affect high-risk patient populations such as immigrants, prisoners, HIV patients and patients who are immunocompromised from receiving various biologic agents for treatment of several autoimmune diseases. Our study shows that although prevalent, overall inpatient admissions associated with GI TB have been decreasing over the last few years; however they are associated with high mortality. Our study highlights continued prevalence of GI TB amongst inpatients in the US, and emphasizes the importance of clinical suspicion when evaluating high risk patients.