Risk factors for death during tuberculosis treatment in Orel, Russia.
METHODS
In Orel, high tuberculosis (TB) case fatality rates have persisted despite successful implementation of the World Health Organization (WHO) global TB control strategy. We conducted a case control study to identify risk factors for mortality among Orel TB patients reported from October 1999 through June 2001. Cases were patients who died within 8 months of treatment initiation. We analyzed data abstracted from medical records using conditional logistic regression.


RESULTS
Over the 21-month period, 63/1069 (5.9%) TB patients overall and 45/521 (8.6%) sputum smear-positive patients died during treatment. Compared to 192 controls, independent risk factors for death for both smear-positive and smear-negative patients included unemployment (adjusted odds ratio [AOR] 4.9, 95% confidence interval [CI] 1.9-12.9), homelessness (AOR 9.5, 95% CI 1.3-70.9), congestive heart failure (AOR 5.4, 95% CI 1.9-15.9), chronic lung disease (AOR 2.4, 95% CI 1.1-5.4), cancer (AOR 7.2, 95% CI 1.2-45.0), bilateral disease on chest X-ray (AOR 6.3, 95% CI 2.3-17.1), and hyperbilirubinemia (AOR 5.2, 95% CI 1.1-25.3). Among deaths, the median time from treatment initiation to death was 35 days.


CONCLUSIONS
The diagnosis and treatment of TB in suspects with the observed comorbidities and risk factors should be aggressively pursued. The association of unemployment and homelessness with mortality suggests a contribution of poverty to death during TB treatment.
Dewan
P K
PK
Epidemic Intelligence Service, Division of Applied Public Health Training, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. puneet.dewan@sfdph.org
Arguin
P M
PM
Kiryanova
H
H
Kondroshova
N V
NV
Khorosheva
T M
TM
Laserson
K
K
Kluge
H
H
Jakubowiak
W
W
Wells
C
C
Kazionny
B
B
D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D002423:Cause of Death; D002648:Child; D023801:Directly Observed Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012426:Russia / Q000453:epidemiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*
D000995:Antitubercular Agents