title: DOT associated with reduced all-cause mortality among tuberculosis patients in Taipei, Taiwan, 2006-2008.
abstract: OBJECTIVE
  To determine whether patients receiving directly observed treatment (DOT) had lower all-cause mortality than those treated with self-administered treatment (SAT) and to identify factors associated with mortality among tuberculosis (TB) patients.
  
  
  METHODS
  All TB patients  in Taipei, Taiwan, diagnosed between 2006 and 2008 were included in a retrospective cohort study.
  
  
  RESULTS
  Among 3624 TB patients, 45.5% received DOT, which was disproportionately offered to older patients and those with more underlying illness and severe TB disease. After controlling for  patients' sociodemographic factors, clinical findings and underlying comorbidities, the odds of death were 40% lower (aOR 0.60, 95%CI 0.5-0.8) among patients treated with DOT than those on SAT. After adjusting for DOT, independent predictors of death included non-Taiwan birth, increasing  age, male, unemployment, end-stage renal disease requiring dialysis, malignancy, acid-fast bacilli smear positivity and pleural effusion.
  
  
  CONCLUSIONS
  DOT was associated with lower all-cause mortality after controlling for confounding factors. DOT should be expanded in Taiwan to improve  critical treatment outcomes among TB patients.
authors.affiliation: Section of Infectious Diseases, Taipei City Hospital, Taipei City Government, Taipei, Taiwan.
authors.forename: Y-F
authors.initials: YF
authors.lastname: Yen
authors.forename: T C
authors.initials: TC
authors.lastname: Rodwell
authors.forename: M-Y
authors.initials: MY
authors.lastname: Yen
authors.forename: H-C
authors.initials: HC
authors.lastname: Shih
authors.forename: B-S
authors.initials: BS
authors.lastname: Hu
authors.forename: L-H
authors.initials: LH
authors.lastname: Li
authors.forename: Y-H
authors.initials: YH
authors.lastname: Shie
authors.forename: P
authors.initials: P
authors.lastname: Chuang
authors.forename: R S
authors.initials: RS
authors.lastname: Garfein
mesh_terms: D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use*; D002423:Cause of Death / Q000639:trends; D023801:Directly Observed Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome; D014376:Tuberculosis / Q000188:drug therapy* / Q000401:mortality
chemical_list: D000995:Antitubercular Agents