Predictors and mortality associated with treatment default in pulmonary tuberculosis.
OBJECTIVE
To identify risk factors for default from pulmonary tuberculosis (TB) treatment and to assess mortality associated with default in Estonia.


METHODS
All patients with culture-confirmed pulmonary TB who started treatment during 2003-2005 were included in a retrospective cohort study.


RESULTS
In 1107 eligible patients, the treatment success rate was 81.5% and the default rate 9.4% (respectively 60.4% and 17.0% in multidrug-resistant TB [MDR-TB]). Independent predictors of treatment default were alcohol abuse (OR 3.22, 95%CI 1.93-5.38), unemployment (OR 3.05, 95%CI 1.84-5.03), MDR-TB (OR 2.17, 95%CI 1.35-3.50), urban residence (OR 1.85, 95%CI 1.00-3.42) and previous incarceration (OR 1.78, 95%CI 1.05-3.03). Of the defaulters, 29.4% died during follow-up (median survival 342.0 days). Cox regression analysis revealed that unemployment was associated with all-cause and TB-related mortality among defaulters (respectively HR 4.58, 95%CI 1.05-20.1 and HR 11.2, 95%CI 1.58-80.2). HIV infection (HR 51.2, 95%CI 6.06-432), sputum smear positivity (HR 9.59, 95%CI 1.79-51.4), MDR-TB (HR 8.56, 95%CI 1.81-40.4) and previous TB (HR 5.15, 95%CI 1.64-16.2) were predictors of TB-related mortality.


CONCLUSIONS
The main risk factors for treatment default can be influenced. Interventions to reduce default should therefore concentrate on socially disadvantaged patients and prevention of alcohol abuse, with special attention given to MDR-TB patients.
Kliiman
K
K
Department of Pulmonary Medicine, University of Tartu, Tartu, Estonia. kai.kliiman@kliinikum.ee
Altraja
A
A
D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000401:mortality; D000995:Antitubercular Agents / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D004957:Estonia / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000401:mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D016017:Odds Ratio; D011329:Prisoners / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D012008:Recurrence; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013183:Sputum / Q000382:microbiology; D013997:Time Factors; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality*; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality*; D014478:Unemployment / Q000706:statistics & numerical data; D014505:Urban Population / Q000706:statistics & numerical data; D055815:Young Adult
D000995:Antitubercular Agents