Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Oct 1;1(3):ofu090.
doi: 10.1093/ofid/ofu090. eCollection 2014 Dec.

Death with tuberculosis in california, 1994-2008

Lisa Pascopella  1 , Pennan M Barry  1 , Jennifer Flood  1 , Kathryn DeRiemer  2
Affiliations

Death with tuberculosis in california, 1994-2008

Lisa Pascopella et al. Open Forum Infect Dis. .

Abstract

Background: Identifying factors associated with tuberculosis (TB) deaths will inform efforts to prevent deaths.

Methods: We examined deaths among patients with culture-confirmed TB reported to the California TB Registry during 1994-2008. We calculated the age-adjusted percentage of deaths before and during TB treatment and estimated trends. We constructed multivariable logistic regression models to identify factors associated with death during treatment.

Results: Of 40 125 patients with culture-confirmed TB, 4565 (11%) died: 1146 (25%) died before treatment started, and 3419 (75%) died during treatment. The age-adjusted percentage of patients who died before and during treatment declined from 1994 to 2008 (3.5% to 2%, and 10.4% to 7.2%, respectively, both P < .0001). We identified several risk factors for death that may be addressed with public health efforts: acquired multidrug resistance (adjusted odds ratio [aOR] = 4.67; 95% confidence interval [CI], 2.09-10.45); care in the private sector (aOR = 3.08; 95% CI, 2.75-3.44); and an initial treatment regimen of <3 drugs (aOR = 2.07; 95% CI, 1.63-2.64). We identified other risk factors for death that could be used as markers for intensified diagnostic and treatment processes in hospital: human immunodeficiency virus coinfection; meningeal, peritoneal, and disseminated TB; substance use; and abnormal chest radiograph without cavities.

Conclusions: In California, 1 in 9 TB patients died with a potentially curable disease. Public health departments might prevent deaths in patients with TB by strengthening partnerships with private providers, intensifying diagnostic and treatment processes for patients at risk of death in hospital, optimizing treatment regimens for patients with comorbidities, and preventing the acquisition of drug resistance.

Keywords: death; public health; risk factors; trends; tuberculosis.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Study population of tuberculosis (TB) patients who had a culture that was positive for Mycobacterium tuberculosis, California, 1994–2008. Shaded boxes show comparison groups for multivariate analysis.
Figure 2.
Figure 2.
Tuberculosis (TB) deaths in California, 1994–2008. A, Tuberculosis deaths before treatment. B, Tuberculosis deaths during treatment.
Figure 3.
Figure 3.
Time from tuberculosis treatment start to death, among patients who died, California, 1994–2008 (n = 3419).
See this image and copyright information in PMC

References

    1. Centers for Disease Control and Prevention (CDC) Atlanta, GA: Department of Health and Human Services; 2013. Reported tuberculosis in the United States, 2012.
    1. Sterling TR, Zhao Z, Khan A, et al. Mortality in a large tuberculosis treatment trial: modifiable and non-modifiable risk factors. Int J Tuberc Lung Dis. 2006;10:542–9. - PubMed
    1. Isanaka S, Mugusi F, Urassa W, et al. Iron deficiency and anemia predict mortality in patients with tuberculosis. J Nutr. 2012;142:350–7. - PMC - PubMed
    1. Centers for Disease Control and Prevention (CDC) Trends in tuberculosis—United States, 2011. MMWR Morb Mortal Wkly Rep. 2012;61:181–5. - PubMed
    1. Curtis AB, McCray E, McKenna M, et al. Completeness and timeliness of tuberculosis case reporting. A multistate study. Am J Prev Med. 2001;20:108–12. - PubMed