title: A population-based study of tuberculosis case fatality in Canada: do Aboriginal peoples fare less well?
abstract: METHODS
  The Province of Alberta, Canada.
  
  
  OBJECTIVE
  To explore trends in tuberculosis (TB) case fatality, compare TB case-fatality rates by population group and determine prognostic factors associated with TB-related death in Alberta from 1996 to 2012.
  
  
  METHODS
  Retrospective cohort analysis.
  
  
  RESULTS
  During the study years, all-cause TB case fatality fell from 10.7% to 6.3%; the fall was attributable to a change in population structure, as there were more foreign-born and fewer older cases with time. A stable 2% of TB cases died without treatment. Compared to other population groups, Canadian-born Aboriginal case patients were more likely to die without treatment and to die younger. Of TB deaths that were TB-related, 68.9% occurred before or during the initial phase of treatment; of these, TB was a contributory cause of death in 77.5%, i.e., another medical condition was the primary cause of death. In multivariate analysis, age >64 years, aboriginality and miliary/disseminated or central nervous system disease were independent predictors for TB-related death.
  
  
  CONCLUSIONS
  Preventive therapy for those with latent tuberculous infection and a high-risk medical condition, early diagnosis of disease, and special support of older, Aboriginal or comorbid cases, once diagnosed, are necessary to further minimise TB case fatality in Alberta, Canada.
authors.affiliation: Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Z
authors.initials: Z
authors.lastname: Gao
authors.affiliation: Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Parhar
authors.affiliation: Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada.
authors.forename: V
authors.initials: V
authors.lastname: Gallant
authors.affiliation: Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: C
authors.initials: C
authors.lastname: Heffernan
authors.affiliation: Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: R
authors.initials: R
authors.lastname: Ahmed
authors.affiliation: Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: M L
authors.initials: ML
authors.lastname: Egedahl
authors.affiliation: Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: R
authors.initials: R
authors.lastname: Long
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000416:Alberta / Q000453:epidemiology / Q000208:ethnology; D002423:Cause of Death / Q000639:trends; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012189:Retrospective Studies; D017678:Sex Distribution; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D014376:Tuberculosis / Q000208:ethnology* / Q000401:mortality*; D055815:Young Adult