title: Permanent employment or public assistance may increase tuberculosis survival among working-age patients in Japan.
abstract: OBJECTIVE
  To measure the effect of employment and health insurance status on the survival of working age tuberculosis (TB) patients in Japan.
  
  
  METHODS
  Retrospective cohort analysis of new smear-positive pulmonary TB patients aged 15-59 years registered in the Japanese national TB surveillance system between 2007 and 2010. We performed univariate and multivariate Cox proportional hazard model analysis. The survival curves for employment and health insurance status were calculated using Kaplan-Meier analysis.
  
  
  RESULTS
  Of 9097 patients studied, 267 (2.9%) died of TB within 12 months. After adjustment with a multivariate model, employment and health insurance status were independently associated with increased risk of TB death: unemployment (HR 2.80, 95%CI 2.11-3.72), absence of insurance (HR 1.48, 95%CI 1.02-2.15). The analysis of survival curves indicated that those with public assistance had almost the same survival rate as insured patients in the unemployed group. Permanent workers (employed >30 days) had the highest survival rates, followed by casual workers (employed <30 days) and the unemployed in the insured group.
  
  
  CONCLUSIONS
  Patients with permanent jobs had better survival rates than unemployed patients and casual workers. Despite being unemployed, receiving public assistance could improve survival. Health measures are required for the unemployed and casual workers.
authors: <sup>*</sup>Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association (RIT/JATA), Tokyo.
authors: K
authors: K
authors: Uchimura
authors: <sup>*</sup>Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association (RIT/JATA), Tokyo.
authors: J
authors: J
authors: Ngamvithayapong-Yanai
authors: <sup>*</sup>Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association (RIT/JATA), Tokyo.
authors: L
authors: L
authors: Kawatsu
authors: <sup>*</sup>Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association (RIT/JATA), Tokyo.
authors: A
authors: A
authors: Ohkado
authors: <sup>†</sup>Fukujuji Hospital, RIT/JATA, Tokyo, Japan.
authors: T
authors: T
authors: Yoshiyama
authors: <sup>*</sup>Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association (RIT/JATA), Tokyo.
authors: K
authors: K
authors: Ito
authors: <sup>*</sup>Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association (RIT/JATA), Tokyo.
authors: N
authors: N
authors: Ishikawa
mesh_terms: D000293:Adolescent; D000328:Adult; D004651:Employment; D005260:Female; D006801:Humans; D007348:Insurance, Health; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011632:Public Assistance; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D015996:Survival Rate; D014376:Tuberculosis / Q000401:mortality*; D014478:Unemployment; D055815:Young Adult