Abstract
The rising geriatric population and the increased susceptibility of this age group to tuberculosis (TB), the deadliest single infectious agent, is bothersome for India. This study tried to explore the demographic and treatment outcome differences between the elderly (aged 60 years and above) and non-elderly TB (<60 years) patients from South India. This study was part of a large ongoing cohort study under the RePORT India consortium. Newly diagnosed TB patients recruited into the cohort between 2014 and 2018 were included in this study. Pretested and standardized questionnaire and tools were used to collect data and were stored securely for the entire cohort. Required demographic, anthropometric and treatment related variables were extracted from this database and analyzed using Stata version 14.0. Prevalence of elderly TB was summarized as percentage with 95% confidence interval (CI). Generalized linear modelling was attempted to find the factors associated with elderly TB. A total of 1,259 eligible TB patients were included into this present study. Mean (SD) of the participants in the elderly and non-elderly group was 65.8 (6.2) and 40.2 (12.0) respectively. Prevalence of elderly TB was 15.6% (95%CI: 13.6%-17.6%) with nearly 71% belonging to 60–69 age category. Male sex, OBC caste, poor education, unemployment, marriage, alcohol consumption and unable to work as per Karnofsky score were found to be significantly associated with an increased prevalence of elderly TB. Unfavorable outcomes (12% vs 6.5%, p value: 0.018), including death (9.3% vs 3.4%, p value: 0.001) were significantly higher among the elderly group when compared to their non-elderly counterparts. The current TB programme should have strategies to maintain follow up with due attention to adverse effects, social support and outcomes. Additional research should focus on predictors for unfavorable outcomes among the elderly TB group and explore ways to handle the same. Rendering adequate social support from the health system side and family side would be a good start.
Highlights
With nearly 10 million new cases reported in 2019, tuberculosis (TB) is the single infectious agent causing maximum morbidity and mortality globally [1]
Patients with score between 80 and 100 were able to carry on normal activity and work without requiring any special care; score between 50 and 70 indicated participants were unable to work but able to live at home and carry out personal needs with varying requirement of assistance; score between 0 and 40 were considered unable to care for self and requires hospital or institutional care [29]
Performance status assessed by Karnofsky score showed that only 364 participants (29%) were able to carry on normal activity and to work without the requirement of special care
Summary
With nearly 10 million new cases reported in 2019, tuberculosis (TB) is the single infectious agent causing maximum morbidity and mortality globally [1]. The Government of India defines the population over the age of 60 years as elderly [3]. The elderly population in India is on the rise due to the increasing life expectancy and declining fertility rates [4]. Age and nutrition-related factors have been shown to negatively impact treatment outcomes among elderly TB [11,12,13]. These could further aggravate the situation by establishing the elderly TB case as a potential source of infection in the community [14,15,16]
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