Abstract
BackgroundAlthough the incidence of tuberculosis (TB) has decreased in South Korea, the mortality rate remains high. TB mortality is a key indicator for TB control interventions. The purpose of this study was to assess early and TB-related mortality during anti-TB treatment and describe the associated clinical characteristics.MethodsA multicenter cross-sectional study was performed across South Korea. Patients with pulmonary TB who died during anti-TB treatment and whose records were submitted to the national TB surveillance system between 2015 and 2017 were enrolled. All TB deaths were categorized based on cause (TB-related or non-TB-related) and timing (early or late). We identified statistical associations using the frequency table, chi-square test, and binary logistic regression.ResultsOf 5595 notifiable mortality cases, 3735 patients with pulmonary TB were included in the analysis. There were 2541 (68.0%) male patients, and 2935 (78.6%) mortality cases were observed in patients older than 65 years. There were 944 (25.3%) cases of TB-related death and 2545 (68.1%) cases of early death. Of all cases, 187 (5.0%) patients were diagnosed post-mortem and 38 (1.0%) patients died on the first day of treatment. Low body mass index (adjusted odds ratio (aOR) = 1.26; 95% confidence interval (CI) = 1.08–1.48), no reported illness (aOR = 1.36; 95% CI = 1.10–1.68), bilateral disease on chest X-ray (aOR = 1.30; 95% CI = 1.11–1.52), and positive acid-fast bacilli smear result (aOR = 1.30; 95% CI = 1.11–1.52) were significantly associated with early death, as well as TB-related death. Acute respiratory failure was the most common mode of non-TB-related death. Malignancy was associated with both late (aOR = 0.71; 95% CI = 0.59–0.89) and non-TB-related (aOR = 0.35; 95% CI = 0.26–0.46) death.ConclusionsA high proportion of TB death was observed in elderly patients and attributed to non-TB-related causes. Many TB-related deaths occurred during the intensive phase, particularly within the first month. Further studies identifying risk factors for different causes of TB death at different phases of anti-TB treatment are warranted for early targeted intervention in order to reduce TB mortality.
Highlights
The incidence of tuberculosis (TB) has decreased in South Korea, the mortality rate remains high
Patients with pulmonary TB who died during anti-TB treatment and whose data were entered into the Korean National TB Surveillance System (KNTSS) [14] at public–private mix (PPM) hospitals across South Korea between 2015 and 2017 were enrolled
There were 2541 (68.0%) male patients, and 2935 (78.6%) mortality cases were observed in elderly patients over 65 years of age
Summary
The incidence of tuberculosis (TB) has decreased in South Korea, the mortality rate remains high. As South Korea becomes an older-aged society, TB mortality and incidence are rapidly increasing among those over 60 years old; this is a huge obstacle to national TB control [5]. A review [6] of the risk factors associated with death during anti-TB treatment, which include human immunodeficiency virus (HIV) positivity, old age, comorbidities, and use of alcohol and drugs, indicates that there are differences in risk factors among regions with low and high incidence of TB. Due to a low prevalence of HIV infection [7, 8] and an intermediate TB burden, South Korea requires a different strategy to control TB mortality. TB mortality is a key indicator for the national TB control program in South Korea. Further studies using nationwide data are required to better understand TB mortality, leading to opportunities for public health intervention that can decrease TB mortality and improve treatment outcomes
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