title: Risk factors for mortality in TB patients: a 10-year electronic record review in a South African province.
abstract: Since 1990, reduction of tuberculosis (TB) mortality has been lower in South Africa than in other high-burden countries in Africa. This research investigated the influence of routinely captured demographic and clinical or programme variables on death in TB patients in the Free State Province.
  
  
  
  A retrospective review of case information captured in the Electronic TB register (ETR.net) over the years 2003 to 2012 was conducted. Extracted data were subjected to descriptive and logistic regression analyses. The outcome variable was defined as all registered TB cases with 'died' as the recorded outcome. The variables associated with increased or decreased odds of dying in TB patients were established. The univariate and adjusted odds ratios (OR and AOR) together with their corresponding 95% confidence intervals (CI) were estimated, taking the clustering effect of the districts into account.
  
  
  
  Of the 190,472 TB cases included in the analysis, 30,991 (16.3%) had 'died' as the recorded treatment outcome. The proportion of TB patients that died increased from 15.1% in 2003 to 17.8% in 2009, before declining to 15.4% in 2012. The odds of dying was incrementally higher in the older age groups: 8-17 years (AOR: 2.0; CI: 1.5-2.7), 18-49 years (AOR: 5.8; CI: 4.0-8.4), 50-64 years (AOR: 7.7; CI: 4.6-12.7), and ≥65 years (AOR: 14.4; CI: 10.3-20.2). Other factors associated with increased odds of mortality included: HIV co-infection (males - AOR: 2.4; CI: 2.1-2.8; females - AOR: 1.9; CI: 1.7-2.1) or unknown HIV status (males - AOR: 2.8; CI: 2.5-3.1; females - AOR: 2.4; CI: 2.2-2.6), having a negative (AOR: 1.4; CI: 1.3-1.6) or a missing (AOR: 2.1; CI: 1.4-3.2) pre-treatment sputum smear result, and being a retreatment case (AOR: 1.3; CI: 1.2-1.4).
  
  
  
  Although mortality in TB patients in the Free State has been falling since 2009, it remained high at more than 15% in 2012. Appropriately targeted treatment and care for the identified high-risk groups could be considered.
authors.affiliation: Centre for Health Systems Research and Development, University of the Free State, P.O. Box 399, Bloemfontein, 9300, South Africa. heunisj@ufs.ac.za.
authors.forename: J Christo
authors.initials: JC
authors.lastname: Heunis
authors.affiliation: Centre for Health Systems Research and Development, University of the Free State, P.O. Box 399, Bloemfontein, 9300, South Africa.
authors.forename: N Gladys
authors.initials: NG
authors.lastname: Kigozi
authors.affiliation: Free State Department of Health, P.O. Box 277, Bloemfontein, 9300, South Africa.|Department of Community Health, University of the Free State, P.O. Box 399, Bloemfontein, 9300, South Africa.
authors.forename: Perpetual
authors.initials: P
authors.lastname: Chikobvu
authors.affiliation: JPS Africa, Postnet Suite 132, Private Bag X14, Brooklyn, Pretoria, 0011, South Africa.
authors.forename: Sonja
authors.initials: S
authors.lastname: Botha
authors.affiliation: Centre for Health Systems Research and Development, University of the Free State, P.O. Box 399, Bloemfontein, 9300, South Africa.
authors.forename: Hcj Dingie
authors.initials: HD
authors.lastname: van Rensburg
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D060085:Coinfection / Q000453:epidemiology; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D013019:South Africa / Q000453:epidemiology; D016896:Treatment Outcome; D014376:Tuberculosis / Q000401:mortality*; D055815:Young Adult
keywords: Free State Province; Mortality; Risk factors; South Africa; Tuberculosis