title: Risk factors for excess mortality and death in adults with tuberculosis in Western Kenya.
abstract: OBJECTIVE
  To evaluate excess mortality and risk factors for death during anti-tuberculosis treatment in Western Kenya.
  
  
  METHODS
  We abstracted surveillance data and compared mortality rates during anti-tuberculosis treatment with all-cause mortality from a health and demographic  surveillance population to obtain standardised mortality ratios (SMRs). Risk factors for excess mortality were obtained using a relative survival model, and for death during treatment using a proportional hazards regression model.
  
  
  RESULTS
  The crude mortality rate during anti-tuberculosis  treatment was 18.0 (95%CI 16.8-19.2) per 100 person-years. The age and sex SMR was 8.8 (95%CI 8.2-9.4). Excess mortality was greater in human immunodeficiency virus (HIV) positive TB patients (excess hazard ratio [eHR] 2.1, 95%CI 1.5-3.1), and lower in patients who were female  or started treatment in a later year. Mortality was high in patients with unknown HIV status (HR 2.9, 95%CI 2.2-3.8) or, if HIV-positive, not on antiretroviral treatment (ART; HR 3.3, 95%CI 2.5-4.5) or not known to be on ART (HR 2.8, 95%CI 2.1-3.7). The attributable fraction  of incomplete uptake of HIV testing and ART on mortality was 31% (95%CI 15-45) compared to HIV-positive patients on ART.
  
  
  CONCLUSIONS
  Increasing the uptake of HIV testing and ART would further reduce mortality during anti-tuberculosis treatment by an estimated 31%.
authors.affiliation: Kenya Medical Research Institute, Centers for Disease Control and Prevention Research and Public Health Collaboration, Kisumu, Kenya. a.h.vanthoog@amc.uva.nl
authors.forename: A H
authors.initials: AH
authors.lastname: van't Hoog
authors.forename: J
authors.initials: J
authors.lastname: Williamson
authors.forename: M
authors.initials: M
authors.lastname: Sewe
authors.forename: P
authors.initials: P
authors.lastname: Mboya
authors.forename: L O
authors.initials: LO
authors.lastname: Odeny
authors.forename: J A
authors.initials: JA
authors.lastname: Agaya
authors.forename: M
authors.initials: M
authors.lastname: Amolloh
authors.forename: M W
authors.initials: MW
authors.lastname: Borgdorff
authors.forename: K F
authors.initials: KF
authors.lastname: Laserson
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use*; D002423:Cause of Death; D060085:Coinfection / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D016016:Proportional Hazards Models; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents; D000995:Antitubercular Agents