Risk factors for poor tuberculosis treatment outcome in Finland: a cohort study.
BACKGROUND
We investigated the patient- and treatment-system dependent factors affecting treatment outcome in a two-year cohort of all treated culture-verified pulmonary tuberculosis (TB) cases to establish a basis for improving outcomes.


METHODS
Medical records of all cases in 1995 - 1996 were abstracted to assess outcome of treatment. Outcome was divided into three groups: favourable, death and other unfavourable. Predictors of unfavourable outcome were assessed in univariate and multivariate analysis.


RESULTS
Among 629 cases a favourable outcome was achieved in 441 (70.1%), 17.2% (108) died and other unfavourable outcome took place in 12.7% (80). Significant independent risk factors for death were male sex, high age, non-HIV -related immunosuppression and any other than a pulmonary specialty being responsible for stopping treatment. History of previous tuberculosis was inversely associated with the risk of death. For other unfavourable treatment outcomes, significant risk factors were pause(s) in treatment, treatment with INH+RIF+EMB/SM, and internal medicine specialty being responsible at the end of the treatment.


CONCLUSIONS
We observed a significant association with unfavourable outcome for the specialty responsible for treatment being other than pulmonary, but not for the volume of cases, which has implications for system arrangements. Poor outcomes associated with immunosuppression and advanced age, with frequent comorbidity, stress a low threshold of suspicion, availability of rapid diagnostics, and early empiric treatment as probable approaches in attempting to improve treatment outcomes in countries with very low incidence of TB.
Vasankari
Tuula
T
Department of Infectious Disease Epidemiology, National Public Health Institute, Mannerheimintie 166, 00300 Helsinki, Finland. tuula.vasankari@utu.fi
Holmström
Pekka
P
Ollgren
Jukka
J
Liippo
Kari
K
Kokki
Maarit
M
Ruutu
Petri
P
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D054242:Emigrants and Immigrants; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D015999:Multivariate Analysis; D011159:Population Surveillance / Q000379:methods; D011635:Public Health Administration / Q000592:standards*; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy