title: Tuberculosis-associated mortality in Shanghai, China: a longitudinal study.
abstract: OBJECTIVE
  To determine excess mortality in a cohort of people with tuberculosis in Shanghai.
  
  
  METHODS
  Participants were local residents in 4 (of 19) districts in Shanghai, registered in one of four tuberculosis clinics between January 1, 2004 and December 31, 2008. Baseline data were collected at the most recent diagnosis of tuberculosis and mortality was assessed between March and May of 2014. We calculated standardized mortality ratios (SMR) and case-fatality rates for all participants and for subgroups. Univariate and multivariate Cox regression models were used to quantify associations between co-morbidities and mortality from all causes and from tuberculosis.
  
  
  RESULTS
  We registered 4569 subjects in the cohort. Overall, the cohort had an SMR for deaths from all causes of 5.2 (95% confidence interval, CI: 4.8-5.6). Males had a higher SMR than females (6.1 versus 3.0). After adjustment for age and sex, hazard ratios (HR) for deaths from all causes were significantly greater in previously treated people (HR: 1.26; 95% CI: 1.08-1.49) and sputum smear-test positive people (HR: 1.55; 95% CI: 1.35-1.78). The risk of death from tuberculosis was also significantly greater for previously treated people (HR: 1.88; 95% CI: 1.24-2.86) and smear positive people (HR: 3.16; 95% CI: 2.06-4.87).
  
  
  CONCLUSIONS
  People with tuberculosis in Shanghai have an increased risk of mortality. Earlier diagnosis and more vigilant follow-up may help to reduce mortality in this group.
authors.affiliation: Department of Epidemiology, School of Public Health and Key Laboratory of Public Health Safety (Ministry of Education), Fudan University, 138 Yi Xue Yuan Road, Shanghai 200032, China .
authors.forename: Weibing
authors.initials: W
authors.lastname: Wang
authors.affiliation: Department of Epidemiology, School of Public Health and Key Laboratory of Public Health Safety (Ministry of Education), Fudan University, 138 Yi Xue Yuan Road, Shanghai 200032, China .
authors.forename: Qi
authors.initials: Q
authors.lastname: Zhao
authors.affiliation: Shanghai Center for Disease Control and Prevention, Shanghai, China .
authors.forename: Zhengan
authors.initials: Z
authors.lastname: Yuan
authors.affiliation: Putuo District Center for Disease Control and Prevention, Shanghai, China .
authors.forename: Yihui
authors.initials: Y
authors.lastname: Zheng
authors.affiliation: Pudong District Center for Disease Control and Prevention, Shanghai, China .
authors.forename: Yixing
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Songjiang District Center for Disease Control and Prevention, Shanghai, China .
authors.forename: Liping
authors.initials: L
authors.lastname: Lu
authors.affiliation: Yangpu District Center for Disease Control and Prevention, Shanghai, China .
authors.forename: Yun
authors.initials: Y
authors.lastname: Hou
authors.affiliation: Department of Epidemiology, School of Public Health and Key Laboratory of Public Health Safety (Ministry of Education), Fudan University, 138 Yi Xue Yuan Road, Shanghai 200032, China .
authors.forename: Yue
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Epidemiology, School of Public Health and Key Laboratory of Public Health Safety (Ministry of Education), Fudan University, 138 Yi Xue Yuan Road, Shanghai 200032, China .
authors.forename: Biao
authors.initials: B
authors.lastname: Xu
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D015897:Comorbidity; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D007223:Infant; D007407:Interviews as Topic; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors; D017678:Sex Distribution; D013183:Sputum / Q000382:microbiology; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality*; D055815:Young Adult