title: Predictors of death among drug-resistant tuberculosis patients in Kuala Lumpur, Malaysia: A retrospective cohort study from 2009 to 2013.
abstract: The emergence of drug-resistant tuberculosis (TB) is a major public health threat. However, little is known about the predictors of death in drug-resistant TB in Malaysia. This study aimed to determine the predictors of death in drug-resistant TB patients, including multidrug-resistant TB (MDR-TB), in Kuala Lumpur, Malaysia. This study adopted a retrospective cohort study design and involved laboratory-confirmed drug-resistant TB patients (n=426) from January 2009 to June 2013. A Cox regression model and Kaplan-Meier curves were used to model the outcome measure. Data were analysed by using SPSS v.20.0 for Windows. In this study, 15.3% (n=65) of the patients died. Among the study patients, 70.9% were monoresistant TB cases, 9.4% were poly-resistant TB and 19.7% were MDR-TB. MDR-TB [adjusted hazard ratio (aHR)=2.23, 95% confidence interval (CI) 1.26-3.95], ethnicity [Malay (aHR=5.95, 95% CI 2.30-15.41), Chinese (aHR=4.01, 95% CI 1.38-11.66) and Indian (aHR=3.76, 95% CI 1.19-11.85)], coronary heart disease (aHR=6.82, 95% CI 2.16-21.50), drug abuse (aHR=3.79, 95% CI 2.07-6.93) and treatment non-compliance (aHR=1.81, 95% CI 1.01-3.27) were independent predictors of poorer survival in the multivariate Cox regression analysis. This study suggests that MDR-TB, local ethnicity, coronary heart disease, history of drug abuse and treatment non-compliance are factors predicting poor survival in drug-resistant TB patients. More emphasis should be given to the management of drug-resistant TB patients with these characteristics to achieve better treatment outcomes.
authors.affiliation: Community Health Department, Faculty of Medicine, Universiti Kebangsaan Malaysia, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, 56000 Kuala Lumpur, Malaysia; Advanced Medical and Dental Institute, University of Science Malaysia, Kepala Batas, 13200 Pulau Pinang, Malaysia. Electronic address: suzana_1910@yahoo.com.
authors.forename: Noorsuzana
authors.initials: N
authors.lastname: Mohd Shariff
authors.affiliation: Community Health Department, Faculty of Medicine, Universiti Kebangsaan Malaysia, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, 56000 Kuala Lumpur, Malaysia.
authors.forename: Shamsul Azhar
authors.initials: SA
authors.lastname: Shah
authors.affiliation: Office of Deputy Director General of Health Malaysia, Ministry of Health Malaysia, 62590 Putrajaya, Malaysia.
authors.forename: Fadzilah
authors.initials: F
authors.lastname: Kamaludin
mesh_terms: D003327:Coronary Disease; D006801:Humans; D053208:Kaplan-Meier Estimate; D008296:Malaysia / Q000453:epidemiology; D055118:Medication Adherence; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D019966:Substance-Related Disorders; D018088:Tuberculosis, Multidrug-Resistant / Q000401:mortality*
keywords: Drug-resistant tuberculosis; Malaysia; Multidrug-resistant; Predictors of death; Survival