Factors associated with death in patients with tuberculosis in Brazil: Competing risks analysis.

Paulo Victor De Sousa Viana,Daniel Antunes Maciel Villela,Natalia Santana Paiva,Paulo Cesar Basta,Ana Luiza De Souza Bierrenbach,Leonardo Soares Bastos,David J Horne

doi:10.1371/journal.pone.0240090

Paulo Victor De Sousa Viana, Daniel Antunes Maciel Villela + Show 5 more

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https://doi.org/10.1371/journal.pone.0240090

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Abstract

This study aimed to analyze the factors associated with likely TB deaths, likely TB-related deaths and deaths from other causes. Understanding the factors associated with mortality could help the strategy to End TB, especially the goal of reducing TB deaths by 95% between 2015 and 2035. A retrospective, population-based cohort study of the causes of death was performed using a competing risk model in patients receiving treatment for TB. Patients had started TB treatment in Brazil 2008-2013 with any death certificates dated in the same period. We used three categories of deaths, according to ICD-10 codes: i) probable TB deaths; ii) TB-related deaths; iii) deaths from other causes. In this cohort, 39,997 individuals (14.1%) died, out of a total of 283,508 individuals. Of these, 8,936 were probable TB deaths (22.4%) and 3,365 TB-related deaths (8.4%), illustrating high mortality rates. 27,696 deaths (69.2%) were from other causes. From our analysis, factors strongly associated with probable TB deaths were male gender (sHR = 1.33, 95% CI: 1.26-1.40), age over 60 years (sHR = 9.29, 95% CI: 8.15-10.60), illiterate schooling (sHR = 2.33, 95% CI: 2.09-2.59), black (sHR = 1.33, 95% CI: 1.26-1.40) and brown (sHR = 13, 95% CI: 1.07-1.19) color/race, from the Southern region (sHR = 1.19, 95% CI: 1.10-1.28), clinical mixed forms (sHR = 1.91, 95% CI: 1.73-2.11) and alcoholism (sHR = 1.90, 95% CI: 1.81-2.00). Also, HIV positive serology was strongly associated with probable TB deaths (sHR = 62.78; 95% CI: 55.01-71.63). In conclusion, specific strategies for active surveillance and early case detection can reduce mortality among patients with tuberculosis, leading to more timely detection and treatment.

Highlights

There is highly effective treatment, tuberculosis (TB) remains the ninth leading cause of death in the world and the leading cause of death among infectious diseases
Factors strongly associated with probable TB deaths were male gender, age over 60 years, illiterate schooling, black and brown color/race, from the Southern region, clinical mixed forms and alcoholism
human immunodeficiency virus (HIV) positive serology was strongly associated with probable TB deaths

Summary

Introduction

There is highly effective treatment, tuberculosis (TB) remains the ninth leading cause of death in the world and the leading cause of death among infectious diseases. Identifying patients at risk of death during TB treatment should be a priority for health surveillance: it is essential for assessing programmatic needs and has the potential to contribute to the targeting of interventions and improvement of treatment monitoring, contributing to the End TB Strategy and to reduce TB mortality by 95% [1]. In this sense, understanding the factors associated with treatment failure may allow the development of strategies to assist in a more effective clinical follow-up of the individuals at risk. It is worth noting that the factors associated with TB deaths mentioned above have not been studied in any nationwide cohort study

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