Patients diagnosed with tuberculosis at death or who died during therapy: association with the human immunodeficiency virus

• Published in: The international journal of tuberculosis and lung disease Vol. 15; no. 4; pp. 465 - 470
• Main Authors: MARKS, S. M, MAGEE, E, ROBISON, V
• Format: Journal Article
• Language: English
• Published: Paris, France IUATLD 01-04-2011; International Union against Tuberculosis and Lung Disease
• Subjects: Adult; Age Factors; Aged; Aged, 80 and over; Antitubercular Agents - therapeutic use; Bacterial diseases; Biological and medical sciences; Female; HIV; HIV Infections - complications; HIV Infections - epidemiology; Human bacterial diseases; Humans; Ill-Housed Persons - statistics & numerical data; Infectious diseases; Male; Medical sciences; Middle Aged; Mortality; Mycobacterium; Pneumology; Population Surveillance; Racial Groups - statistics & numerical data; Respiratory system : syndromes and miscellaneous diseases; Risk Factors; Sex Factors; Sputum - microbiology; Tuberculosis; Tuberculosis - complications; Tuberculosis - drug therapy; Tuberculosis - epidemiology; Tuberculosis - mortality; Tuberculosis and atypical mycobacterial infections; Tuberculosis, Multidrug-Resistant - drug therapy; Tuberculosis, Multidrug-Resistant - epidemiology; Tuberculosis, Multidrug-Resistant - mortality; United States - epidemiology; Young Adult; United States; USA; Human; Prognosis; Respiratory disease; Mortality; Retroviridae; Mycobacterial infection; Lentivirus; Infection; Virus; Association; Treatment; Tuberculosis; HIV; Bacteriosis; Death; Diagnosis; Human immunodeficiency virus; WHO; Pneumology
• ISSN: 1027-3719; 1815-7920
• DOI: 10.5588/ijtld.10.0259

OBJECTIVES: To describe trends and risk factors for tuberculosis (TB) mortality.DESIGN: We calculated trends, identified patient characteristics associated with TB diagnosis at death or death during TB treatment, and described diagnostic procedures using the United States National
TB Surveillance System for 1997-2005.RESULTS: Human immunodeficiency virus (HIV) infected TB patients had an adjusted odds ratio (aOR) of 4-11 for TB diagnosis at death (foreign-born non-Whites, aOR = 11) and of 3-19 for death during TB treatment vs. non-HIV-infected
patients. Odds increased by age. Hispanic males had an aOR of 2 for TB diagnosis at death compared with female non-Hispanics. Multidrug-resistant TB (MDR-TB) patients had a three times greater aOR of death during treatment than non-MDR patients. American Indians, Black females, residents in
long-term care facilities, US-born patients, and non-HIV-infected homeless persons aged 25-44 years each had an aOR of 2 for mortality during treatment; 86% of pulmonary patients diagnosed at death had a chest radiograph, but 34% had no sputum smear or culture reported.CONCLUSION:
During 1997-2005, controlling for age, HIV remained the characteristic with the greatest aOR for TB diagnosis at death or death during TB therapy. Race/ethnicity, country of birth and homelessness further increased the adjusted odds of death. Results show possible missed opportunities
for TB diagnosis prior to death.