MORTALITY OF TUBERCULOSIS PATIENTS IN THE METROPOLIS IN THE CONDITIONS OF EXTERNAL AND INTERNAL MIGRATION

Abstract

The study analyzed the data of the register of the tuberculosis monitoring system in Moscow on total 3372 cases of death of TB patients from all causes that occurred in the city in 2017-2022, including 1239 deaths from tuberculosis, 1144 deaths from HIV-TB (B20.0/ B20.7) and 989 deaths from other causes. The relationship between the distribution of causes of death and the group of the population to which the deceased belonged was shown, among which 56.9% were from the resident population, 20.8% of homeless people, 16.0% of residents of other regions of Russia (Moscow nonresidents) and 6.3% of foreigners. The importance of controlling the mortality of TB patients from other causes was noted, among which, for those who died from the permanent population, Moscow non-residents and foreigners, more than 80% were associated with concomitant diseases, the course of which is aggravated in the presence of tuberculosis. The most important epidemiological characteristics of cases of death of TB patients are considered - the age and sex structure, the place of death and the status of the patient’s lifetime registration as a TB patient. Among the dead TB patients, about 75% were men and 53.6% were over 45 years old. The proportion of deaths outside a tuberculosis or infectious diseases hospitals, totaling 37.0%, largely depended both on the causes of death of TB patients and on the population group: 24.7% – for Moscow non-residents, about 40% – for homeless people, for cases of those who died from other causes, the proportion of these cases was 50% or more, and for those who died from HIV-TB – from 5.8% among Moscow non-residents to 21.9% among foreigners. In general, the proportion of deaths less than 1 month after registration as a TB patient (including post-mortem detection) was 37.1%, with 30.8% for the permanent population and almost 50% for homeless people and foreigners. Multivariate analysis showed that dying before registration or less than 1 month after registration as a TB patient was 3.5 times more likely to occur in a non-TB or infectious diseases hospital, and 2.6 times more likely to occur in patients with generalized severe forms of tuberculosis, and 1.5 times in foreigners. Belonging to the resident population was a «protective» factor in terms of the fact that death will occur earlier than 1 month after registration as a TB patient, that is, the chance of belonging to TB patients from the resident population in this group of deaths is 1.3 times lower compared to homeless people, Moscow non-residents and foreigners. Having confirmed that there is a generally favorable situation with tuberculosis in the Moscow, it is shown that for its further effective control it is necessary to constantly monitor the mortality of tuberculosis patients from all causes in the context of various population groups residing in the city, with an assessment of the proportion of deaths not in tuberculosis or infectious hospitals and the proportion of those diagnosed posthumously and up to a month after registration as a TB patient.