title: Effects of gender and age on development of concurrent extrapulmonary tuberculosis in patients with pulmonary tuberculosis: a population based study.
abstract: Most cases of adult-onset tuberculosis (TB) result from reactivation of a pre-existing Mycobacterium tuberculosis infection. Mycobacterium tuberculosis usually invades the respiratory tract and most patients develop intrapulmonary TB; however, some patients develop concurrent pulmonary and extra-pulmonary TB. The purpose of the present study was to identify the demographic and clinical factors associated with an increased risk of concurrent extra-pulmonary diseases in patients with pulmonary TB. We compared patients who had isolated pulmonary TB with patients who had concurrent pulmonary and extra-pulmonary TB. We initially analyzed one-million randomly selected subjects from the population-based Taiwan National Health Insurance database. Based on analysis of 5414 pulmonary TB patients in this database, women were more likely than men to have concurrent extra-pulmonary TB (OR: 1.30, p = 0.013). A separate analysis of the Kaohsiung Medical University Hospital database, which relied on sputum culture-proven pulmonary TB, indicated that women were more likely than men to have concurrent extra-pulmonary TB (OR: 1.62, p = 0.039). There was no significant gender difference in extra-pulmonary TB for patients younger than 45 years in either database. However, for patients 45 years and older, women were more likely than men to have concurrent extra-pulmonary TB (insurance database: 9.0% vs. 6.8%, p = 0.016, OR: 1.36; hospital database: 27.3% vs. 16.0%, p = 0.008, OR = 1.98). Our results indicate that among patients who have pulmonary TB, older females have an increased risk for concurrent extra-pulmonary TB.
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors.forename: Chun-Yu
authors.initials: CY
authors.lastname: Lin
authors.forename: Tun-Chieh
authors.initials: TC
authors.lastname: Chen
authors.forename: Po-Liang
authors.initials: PL
authors.lastname: Lu
authors.forename: Chung-Chih
authors.initials: CC
authors.lastname: Lai
authors.forename: Yi-Hsin
authors.initials: YH
authors.lastname: Yang
authors.forename: Wei-Ru
authors.initials: WR
authors.lastname: Lin
authors.forename: Pei-Ming
authors.initials: PM
authors.lastname: Huang
authors.forename: Yen-Hsu
authors.initials: YH
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D005783:Gender Identity; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis; D012306:Risk; D013624:Taiwan / Q000453:epidemiology; D014376:Tuberculosis / Q000453:epidemiology* / Q000209:etiology* / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000150:complications*; D055815:Young Adult