Comorbidity clusters associated with length of hospital stay in patients with tuberculosis

Abstract

Introduction: Tuberculosis (TB) is a global public health threat with significant burden to society and healthcare system. Outpatient treatment and shorter hospital stays may reduce costs. TB-associated length of hospital stay (LOS) is heterogeneous and it is of interest to better understand risk factors associated with longer LOS. The aim of this study was to investigate the relationship between comorbidities and LOS in patients hospitalized for TB. Methods: A Swiss-wide hospitalization database provided by the Swiss Federal Office for Statistics was used. Month and year of admission, gender, age, LOS and in-hospital mortality were extracted for all hospitalization cases with TB as primary diagnosis and compared with controls matched for age, gender and admission date. Information about type of TB, age and comorbidities (up-to 50 co-diagnoses coded using ICD-10) were analyzed. Results: Over the period 2002-2015, the median LOS of 7392 patients hospitalized primarily for TB was stable at 14 days [IQR: 6 - 22 days] and was longer in miliary TB and older patients. TB-associated comorbidities included HIV, liver diseases, anemia, malnutrition and diseases of the genitourinary system. Longer LOS was strongly associated with 3 clusters of comorbidity: 1) Malnutrition, cachexia and anemia (median LOS: 20 days [IQR: 13 - 31 days], p Conclusion: We identified clusters of comorbidities significantly associated with longer LOS in patients with TB. Comorbidities are relevant determinants for prolonged hospital stays in TB.