High mortality during tuberculosis treatment does not indicate long diagnostic delays in Vietnam: a cohort study.
BACKGROUND
Delay in tuberculosis diagnosis and treatment initiation may increase disease severity and mortality. In evaluations of tuberculosis control programmes high fatality rates during tuberculosis treatment, are used as an indicator of long delays in low HIV-prevalence settings. However, data for this presumed association between delay and fatality are lacking. We assessed the association between diagnostic delay and mortality of new smear-positive pulmonary tuberculosis patients in Vietnam.


METHODS
Follow-up of a patient cohort included in a survey of diagnostic delay in 70 randomly selected districts. Data on diagnosis and treatment were extracted from routine registers. Patients who had died during the course of treatment were compared to those with reported cure, completed treatment or failure (survivors).


RESULTS
Complete data were available for 1881/2093 (89.9%) patients, of whom 82 (4.4%) had died. Fatality was 4.5% for patients with < or = 4 weeks delay, 5.0% for 5- < or = 8 weeks delay (aOR 1.11, 95%CI 0.67-1.84) and 3.2% for > 9 weeks delay (aOR 0.69, 95%CI 0.37-1.30). Fatality tended to decline with increasing delay but this was not significant. Fatality was not associated with median diagnostic delay at district level (Spearman's rho = -0.08, P = 0.5).


CONCLUSIONS
Diagnostic delay is not associated with treatment mortality in Vietnam at individual nor district level, suggesting that high case fatality should not be used as an indicator of long diagnostic delay in national tuberculosis programmes.
Vree
Marleen
M
Research unit, KNCV Tuberculosis Foundation, The Hague, The Netherlands. vreem@kncvtbc.nl
Huong
Nguyen T
NT
Duong
Bui D
BD
Co
Nguyen V
NV
Sy
Dinh N
DN
Cobelens
Frank G
FG
Borgdorff
Martien W
MW
D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012042:Registries; D013183:Sputum / Q000382:microbiology; D013997:Time Factors; D017211:Treatment Failure; D014376:Tuberculosis / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality*; D014744:Vietnam / Q000453:epidemiology
Int J Tuberc Lung Dis. 2001 Mar;5(3):213-5
11326818
Am J Respir Crit Care Med. 2002 Apr 1;165(7):927-33
11934716
Int J Tuberc Lung Dis. 2002 Dec;6(12):1114-7
12546121
Lancet. 2003 Sep 13;362(9387):887-99
13678977
JAMA. 1996 Oct 16;276(15):1223-8
8849749
Diabetes Care. 1998 Sep;21(9):1414-31
9727886
Int J Tuberc Lung Dis. 1999 Jun;3(6):483-7
10383060
Indian J Chest Dis Allied Sci. 2005 Jan-Mar;47(1):19-23
15704711
Int J Tuberc Lung Dis. 2005 Feb;9(2):151-6
15732733
Int J Tuberc Lung Dis. 2006 Jan;10(1):45-51
16466036
Int J Tuberc Lung Dis. 2006 Feb;10(2):184-7
16499258
Int J Tuberc Lung Dis. 2006 Apr;10(4):390-5
16602402
Int J Tuberc Lung Dis. 2006 Apr;10(4):422-8
16602407
Int J Tuberc Lung Dis. 2006 Jun;10(6):670-5
16776455
Int J Tuberc Lung Dis. 2007 Apr;11(4):392-7
17394684
BMC Public Health. 2007;7:110
17567521
BMC Public Health. 2007;7:134
17605770
Emerg Infect Dis. 2002 Nov;8(11):1327-33
12453365