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. 2011 Apr;15(4):465-70.
doi: 10.5588/ijtld.10.0259.

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

S M Marks  1 , E Magee, V Robison
Affiliations

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

S M Marks et al. Int J Tuberc Lung Dis. 2011 Apr.

Abstract

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.

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Figures

Figure 1
Figure 1
TB-associated mortality, number and percentage of cases. A. TB diagnosed at death, NTSS, 1997–2005. B. Death during TB treatment, NTSS, 1997–2005. TB = tuberculosis; NTSS = United States National TB Surveillance System.
Figure 2
Figure 2
A. Case-fatality rates for TB diagnosed at death by race/ethnicity. Rates not shown for native Hawaiians (range 0–4.7, average = 2.7). B. Case-fatality rates for death during TB treatment by race/ethnicity. Rates not shown for native Hawaiians (range 0–9.6, average = 4.8). NH = native Hawaiians; AIAN = American Indian/Alaskan native.
Figure 3
Figure 3
Reported diagnostics of pulmonary and extra-pulmonary TB cases. A. Reported diagnostics of pulmonary TB cases. B. Reported diagnostics of extra-pulmonary TB cases. CXR = chest X-ray; exam = examination; TB = tuberculosis.
See this image and copyright information in PMC

References

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