Tuberculosis in the elderly in Germany

Abstract

To the Editors: Germany has a low tuberculosis (TB) incidence with a decreasing trend [1]. However, the proportion of TB patients aged ≥60 yrs is increasing (1976: 26.5%; 1986: 30.9%; 1996: 33.7%; 2006: 34.8%. 1976 and 1986 figures are for the Federal Republic of Germany only), reflecting demographic changes. Age-related factors not only increase the risk of TB reactivation but also enhance susceptibility to TB infection, abetting outbreaks, e.g. in nursing homes [2, 3]. To optimise healthcare services and TB control in this subpopulation of growing impact, detailed knowledge of the epidemiological features of TB in the elderly is needed. National German TB notification data from 2002 to 2006 were analysed as a pooled 5-yr data set stratified into two age groups: TB patients 15–59 yrs (referred to as “younger adults”) and those aged ≥60 yrs (“the elderly”). For both groups, proportions of TB cases with reference to demographic factors, affected organs, drug resistance, case finding and treatment outcome were determined. Mortality (based on treatment outcome notification data), TB incidence, and age-specific TB incidence in 5-yr strata were calculated based on population data from regional statistical offices (time averaged 2002–2006). As the country of birth was unknown for the general population, origin-related TB incidence was derived from citizenship information. Proportion (%) and incidence (cases per 100,000 population) were compared between both groups using the Z-test. Odds ratios (ORs), 95% confidence intervals (CIs) and corresponding p-values were specified. Data were collected using the electronic reporting system SurvNet@rki (Robert Koch Institute, Berlin, Germany) and analysed using SPSS version 15 (SPSS Inc., Chicago, IL, USA), Excel (Microsoft Corporation, Redwood, CA, USA) and Stata version 11.0 (StataCorp LP, College Station, TX, USA). A total of 31,459 TB cases aged ≥15 yrs were identified. Details of the study set …