title: Predictors of hospitalization of tuberculosis patients in Montreal, Canada: a retrospective cohort study.
abstract: BACKGROUND
  Hospitalization is the most costly health system component of tuberculosis (TB) control programs. Our objectives were to identify how frequently patients are hospitalized, and the factors associated with hospitalizations and length-of-stay (LOS) of TB patients in a large Canadian city.
  
  
  METHODS
  We extracted data from the Montreal TB Resource database, a retrospective cohort of all active TB cases reported to the Montreal Public Health Department between January 1996 and May 2007. Data included patient demographics, clinical characteristics, and dates of treatment and hospitalization. Predictors of hospitalization and LOS were estimated using logistic regression and Cox proportional hazards regression, respectively.
  
  
  RESULTS
  There were 1852 active TB patients. Of these, 51% were hospitalized initially during the period of diagnosis and/or treatment initiation (median LOS 17.5 days), and 9.0% hospitalized later during treatment (median LOS 13 days). In adjusted models, patients were more likely to be hospitalized initially if they were children, had co-morbidities, smear-positive symptomatic pulmonary TB, cavitary or miliary TB, and multi- or poly-TB drug resistance. Factors predictive of longer initial LOS included having HIV, renal disease, symptomatic pulmonary smear-positive TB, multi- or poly-TB drug resistance, and being in a teaching hospital.
  
  
  CONCLUSIONS
  We found a high hospitalization rate during diagnosis and treatment of patients with TB. Diagnostic delay due to low index of suspicion may result in patients presenting with more severe disease at the time of diagnosis. Earlier identification and treatment, through interventions to increase TB awareness and more targeted prevention programs, might reduce costly TB-related hospital use.
authors.affiliation: Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.|Division of Respiratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.|Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Ronald
authors.affiliation: Division of Respiratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.|Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.|Institute for Heart and Lung Health, University of British Columbia, Vancouver, Canada.
authors.forename: J Mark
authors.initials: JM
authors.lastname: FitzGerald
authors.affiliation: Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.|Respiratory Epidemiology and Clinical Research Unit (RECRU)/ Montreal Chest Institute, McGill University Health Centre, Room 419, 2155 Guy St, Montreal, QC, H3H 2R9, Canada.|Department of Medicine, McGill University, Montreal, QC, Canada.
authors.forename: Andrea
authors.initials: A
authors.lastname: Benedetti
authors.affiliation: Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Boivin
authors.affiliation: Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.|Respiratory Epidemiology and Clinical Research Unit (RECRU)/ Montreal Chest Institute, McGill University Health Centre, Room 419, 2155 Guy St, Montreal, QC, H3H 2R9, Canada.
authors.forename: Kevin
authors.initials: K
authors.lastname: Schwartzman
authors.affiliation: Department of Family Medicine, McGill University, Montreal, QC, Canada.
authors.forename: Gillian
authors.initials: G
authors.lastname: Bartlett-Esquilant
authors.affiliation: Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada. dick.menzies@mcgill.ca.|Respiratory Epidemiology and Clinical Research Unit (RECRU)/ Montreal Chest Institute, McGill University Health Centre, Room 419, 2155 Guy St, Montreal, QC, H3H 2R9, Canada. dick.menzies@mcgill.ca.
authors.forename: Dick
authors.initials: D
authors.lastname: Menzies
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D057210:Delayed Diagnosis; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011792:Quebec / Q000453:epidemiology / Q000208:ethnology; D012189:Retrospective Studies; D014376:Tuberculosis / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D014391:Tuberculosis, Miliary / Q000175:diagnosis / Q000188:drug therapy; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D055815:Young Adult
keywords: Active tuberculosis; Epidemiology; Health service utilization; Length of hospital stay; Survival analysis