Tuberculosis in older people: a retrospective and comparative study from Hong Kong.
OBJECTIVE
To compare tuberculosis (TB) in older and younger patients.


METHODS
A retrospective and comparative observational study.


METHODS
Four chest clinics and two chest hospitals in Hong Kong.


METHODS
All notifications from the participating hospitals and clinics in 1996 were extracted from the TB notification registry. The characteristics of patients aged 65 and older were compared with a one-in-three random sampling of those aged 16 to 64.


METHODS
Demographic, clinical, radiological, and laboratory data of the two groups were compared alongside treatment and outcomes.


RESULTS
Older people with TB were more likely to be male, to smoke, to have had TB previously, to have coexisting medical diseases, to be socioeconomically disadvantaged, and to weigh less than younger people with TB. Dyspnea, weight loss, and malaise were more common, whereas extrathoracic lymph node enlargement was less common. Chest radiograph showed more extensive disease and lower zone involvement. Positive tuberculin test was present in only 61.9%. Sputum bacteriology was more likely to be positive. There was a longer delay in presentation and commencement of treatment, and 77.2% required at least one admission. Adverse effects of treatment, notably hepatic dysfunction, occurred more commonly. Fluoroquinolones appeared well tolerated. Only 72.5% of the older people were cured or completed their treatment. Mortality was 16%. Age of 65 and older, comorbidity, socioeconomic disadvantage, moderate-extensive disease, positive sputum smear, and poor adherence were factors independently associated with unfavorable outcomes (P <.001 to P = .01; odds ratios = 1.61-27.02).


CONCLUSIONS
Substantial differences were found between older and younger TB patients. Many of these were associated with unfavorable outcome. Increased awareness in disease recognition and better medical and social support are therefore needed in addressing the growing problem of TB in older people.
Tuberculosis and Chest Service, Department of Health, Hong Kong, China. cclpnc@netvigator.com
Chi C
CC
Leung
Wing W
WW
Yew
Chi K
CK
Chan
Chi H
CH
Chau
Cheuk M
CM
Tam
Chak W
CW
Lam
Wai O
WO
Tam
Kam S
KS
Lau
Wai T
WT
Liu
D000293:Adolescent; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use; D016009:Chi-Square Distribution; D015897:Comorbidity; D004359:Drug Therapy, Combination; D005260:Female; D006723:Hong Kong / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014376:Tuberculosis / Q000188:drug therapy / Q000453:epidemiology*
D000995:Antitubercular Agents