Factors associated with mortality in patients with tuberculosis.
BACKGROUND
Known risk factors for death following a diagnosis of tuberculosis may not be applicable to current U.S. cases. We evaluated the factors associated with all-cause mortality in patients with tuberculosis in Washington State.


METHODS
Using data from the Tuberculosis Information Management System of Washington State, we conducted a cohort study of all residents diagnosed with tuberculosis from 1993 through 2005. Death from any cause was ascertained through the Washington State Death Certificate Data Files. Proportional hazards models were used to estimate the independent effect on all-cause mortality of demographic, clinical, and behavioral characteristics.


RESULTS
During a median follow-up of 6 years in 3451 patients treated for tuberculosis, there were 417 deaths. Mortality was independently associated with increasing age, male gender, HIV-coinfection, and U.S. birth. Within 1 year of tuberculosis diagnosis, treatment by a private provider and the use of directly observed therapy were also independently associated with increased mortality. In addition, an interaction term of private provider times directly observed therapy was also significantly associated with mortality.


CONCLUSIONS
We identified factors independently associated with increased all-cause mortality following a diagnosis of tuberculosis. The associations between mortality and provider type should be evaluated with more thorough adjustment for severity of illness, but suggest important directions for future research.
Horne
David J
DJ
Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA. dhorne@u.washington.edu
Hubbard
Rebecca
R
Narita
Masahiro
M
Exarchos
Alexia
A
Park
David R
DR
Goss
Christopher H
CH
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006282:Health Personnel / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014376:Tuberculosis / Q000453:epidemiology* / Q000401:mortality*; D014861:Washington / Q000453:epidemiology
Eur Respir J. 2006 Nov;28(5):980-5
16837502
Epidemiol Infect. 2007 Oct;135(7):1069-76
17288641
CMAJ. 2006 Sep 26;175(7):749-53
17001055
Clin Infect Dis. 2001 Nov 15;33(10):1762-9
11595988
MMWR Recomm Rep. 1993 May 21;42(RR-7):1-8
8413157
AIDS. 2004 Sep 24;18(14):1933-41
15353979
Am J Respir Crit Care Med. 2004 Sep 1;170(5):561-6
15184210
JAMA. 1999 Aug 18;282(7):677-86
10517722
J Clin Epidemiol. 2001 Jan;54(1):40-50
11165467
Can J Public Health. 2004 May-Jun;95(3):I14-21
15191127
Int J Tuberc Lung Dis. 2006 May;10(5):542-9
16704037
Trans R Soc Trop Med Hyg. 1999 Sep-Oct;93(5):552-7
10696421
Respir Res. 2009 Dec 01;10:121
19951437
Am J Respir Crit Care Med. 2004 May 15;169(10):1103-9
14742301
Int J Tuberc Lung Dis. 2002 Dec;6(12):1114-7
12546121
N Engl J Med. 1994 Apr 28;330(17):1179-84
8139628
JAMA. 1996 Oct 16;276(15):1223-8
8849749
Int J Tuberc Lung Dis. 2009 Mar;13(3):328-34
19275792
Am J Prev Med. 2001 Feb;20(2):108-12
11165451
Am J Respir Crit Care Med. 2005 Nov 1;172(9):1169-227
16249321